Provider Demographics
NPI:1669625422
Name:FOOTE, PERRY ALBERT JR
Entity type:Individual
Prefix:
First Name:PERRY
Middle Name:ALBERT
Last Name:FOOTE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9325 SW 41ST LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-4169
Mailing Address - Country:US
Mailing Address - Phone:352-338-2026
Mailing Address - Fax:
Practice Address - Street 1:9325 SW 41ST LN
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-4169
Practice Address - Country:US
Practice Address - Phone:352-338-2026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 13245207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology