Provider Demographics
NPI:1457369985
Name:PERRY, RICHARD M (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:PERRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 OLD HOUSTON RD
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-6830
Mailing Address - Country:US
Mailing Address - Phone:936-295-7100
Mailing Address - Fax:866-594-8929
Practice Address - Street 1:3001 OLD HOUSTON RD
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-6830
Practice Address - Country:US
Practice Address - Phone:936-295-7100
Practice Address - Fax:866-594-8929
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7131251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131151601Medicaid
TXC50397Medicare UPIN
TX00352MMedicare UPIN