Provider Demographics
NPI:1952375776
Name:PERRY, JOSEPH L (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:PERRY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 S HARBOR CITY BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1938
Mailing Address - Country:US
Mailing Address - Phone:321-499-4646
Mailing Address - Fax:321-270-9449
Practice Address - Street 1:709 S HARBOR CITY BLVD STE 110
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1938
Practice Address - Country:US
Practice Address - Phone:321-499-4646
Practice Address - Fax:321-270-9449
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109578363A00000X
TXPA02502363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9SQWDOtherFLORIDA BLUE
FL9SQWDOtherFLORIDA BLUE
P22898Medicare UPIN