Healthcare Provider Details

I. General information

NPI: 1861729311
Provider Name (Legal Business Name): V. BRYAN PERRY MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 W 42ND AVE
PINE BLUFF AR
71603-7008
US

IV. Provider business mailing address

1722 W 42ND AVE
PINE BLUFF AR
71603-7008
US

V. Phone/Fax

Practice location:
  • Phone: 870-535-4141
  • Fax: 870-535-9180
Mailing address:
  • Phone: 870-535-4141
  • Fax: 870-535-9180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberC2651
License Number StateAR

VIII. Authorized Official

Name: DR. VIRGIL BRYAN PERRY
Title or Position: PHY/OWNER
Credential: MD PA
Phone: 870-535-4141