Provider Demographics
NPI: | 1205881752 |
---|---|
Name: | PERRY, PAUL K (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | PAUL |
Middle Name: | K |
Last Name: | PERRY |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | PO BOX 44008 |
Mailing Address - Street 2: | UFJP PROVIDER ENROLLMENT |
Mailing Address - City: | JACKSONVILLE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32231-4008 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3100 E FLETCHER AVE |
Practice Address - Street 2: | |
Practice Address - City: | TAMPA |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33613-4613 |
Practice Address - Country: | US |
Practice Address - Phone: | 813-971-6000 |
Practice Address - Fax: | 813-615-7590 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-05-23 |
Last Update Date: | 2010-03-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | ME40177 | 207P00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 036634000 | Medicaid | |
FL | 30479 | Other | BCBS OF FLORIDA |
FL | 30479T | Medicare PIN | |
FL | 30479S | Medicare PIN | |
D54010 | Medicare UPIN | ||
FL | P00289058 | Medicare PIN | |
FL | 30479 | Other | BCBS OF FLORIDA |
FL | 30479R | Medicare PIN |