MEDICARE: DR. ROGER W PERRY PHD

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	103T00000X	Psychologist	20040411A	IN

General Provider Information

NPI Number	:	1942491832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER W PERRY PHD

Provider Business Mailing Address
First Line	:	9959 PARKWAY DR
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46037-9332
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	546 E 17TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1702
Country	:	US
Telephone Number	:	317-536-1225
Fax Number	:

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

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	08/06/2007

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