MEDICARE: DR. ROBERT ELVIE PERRY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	R3H52	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659376234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT ELVIE PERRY M.D.

Provider Business Mailing Address
First Line	:	343 GRAPHITE LN
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-9148
Country	:	US
Telephone Number	:	573-651-3259
Fax Number	:	573-332-0206

Provider Business Practice Location Address
First Line	:	1701 LACEY ST
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-5230
Country	:	US
Telephone Number	:	573-331-6353
Fax Number	:	573-331-6378

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	03/09/2015

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