Provider Demographics
NPI:1265543813
Name:PERRY, ALLAN W JR (MD)
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:W
Last Name:PERRY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1808 VERDUGO BLVD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1477
Mailing Address - Country:US
Mailing Address - Phone:818-790-0385
Mailing Address - Fax:818-790-4153
Practice Address - Street 1:1808 VERDUGO BLVD
Practice Address - Street 2:SUITE 118
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1477
Practice Address - Country:US
Practice Address - Phone:818-790-0385
Practice Address - Fax:818-790-4153
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-10-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG43094208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G430940Medicaid
CAG43094Medicare ID - Type Unspecified
CA00G430940Medicaid