Provider Demographics
NPI:1639304942
Name:PERRY, DWAN ROZZEL (DO)
Entity type:Individual
Prefix:DR
First Name:DWAN
Middle Name:ROZZEL
Last Name:PERRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2050 VERSAILLES RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-1405
Mailing Address - Country:US
Mailing Address - Phone:859-257-4888
Mailing Address - Fax:859-323-1123
Practice Address - Street 1:310 S LIMESTONE STREET SUITE A100A
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-8202
Practice Address - Country:US
Practice Address - Phone:859-257-2573
Practice Address - Fax:859-323-0096
Is Sole Proprietor?:No
Enumeration Date:2009-05-16
Last Update Date:2018-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0102203436207QS0010X, 2081S0010X
KYTP9902081S0010X
TN27362081S0010X
KY041972081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I256904Medicare PIN