Provider Demographics
NPI:1336313170
Name:DIAS PERERA, ANTON SURATH NISETUS (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTON
Middle Name:SURATH NISETUS
Last Name:DIAS PERERA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6029 WALNUT GROVE RD
Mailing Address - Street 2:SUITE # 401
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2112
Mailing Address - Country:US
Mailing Address - Phone:901-747-3067
Mailing Address - Fax:901-747-2966
Practice Address - Street 1:6029 WALNUT GROVE RD
Practice Address - Street 2:SUITE # 401
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2112
Practice Address - Country:US
Practice Address - Phone:901-747-3067
Practice Address - Fax:901-747-2966
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2015-09-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN458202086S0129X, 208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery