Provider Demographics
NPI:1861548463
Name:PERRY, JOHN J (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:PERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-500-5633
Mailing Address - Fax:321-617-5633
Practice Address - Street 1:1700 W HIBISCUS BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2615
Practice Address - Country:US
Practice Address - Phone:321-500-5633
Practice Address - Fax:321-617-5633
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103032207XX0801X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00901827OtherFL HFMG RR MEDICARE
FL002538000Medicaid
FL148YUOtherBCBS OF FL
FL9146570OtherAETNA
FLP00895831OtherRR MEDICARE
FLLQ304OtherFL HFMG MEDICARE
FLDI5160ZMedicare PIN