Provider Demographics
NPI:1245463231
Name:PERRY, CORY D (IDC)
Entity type:Individual
Prefix:MR
First Name:CORY
Middle Name:D
Last Name:PERRY
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS ELROD FFG 55
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09568-1509
Mailing Address - Country:US
Mailing Address - Phone:757-444-2000
Mailing Address - Fax:
Practice Address - Street 1:USS ELROD FFG 55
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09568-1509
Practice Address - Country:US
Practice Address - Phone:757-444-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman