Provider Demographics
NPI:1538298732
Name:THEODORE G PERRY MD PA
Entity type:Organization
Organization Name:THEODORE G PERRY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:G
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-562-9899
Mailing Address - Street 1:3755 7TH TER
Mailing Address - Street 2:SUITE 204
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6528
Mailing Address - Country:US
Mailing Address - Phone:772-562-9899
Mailing Address - Fax:772-562-6237
Practice Address - Street 1:3755 7TH TER
Practice Address - Street 2:SUITE 204
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6528
Practice Address - Country:US
Practice Address - Phone:772-562-9899
Practice Address - Fax:772-562-6237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020037078OtherRAILROAD MEDICARE
FLK1094Medicare PIN