Provider Demographics
NPI:1831245554
Name:PERRY, ROBERT G (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:PERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2250 NW 136 AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2586
Mailing Address - Country:US
Mailing Address - Phone:954-302-7960
Mailing Address - Fax:954-628-5084
Practice Address - Street 1:2250 NW 136 AVE STE 100
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2586
Practice Address - Country:US
Practice Address - Phone:954-302-7960
Practice Address - Fax:546-285-0849
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94381207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME94381OtherFLORIDA LICENSE
FLBP8607256OtherDEA
FLME94381OtherFLORIDA LICENSE
FL98S61Medicare ID - Type Unspecified