Healthcare Provider Details

I. General information

NPI: 1922202373
Provider Name (Legal Business Name): CHRISTOPHER ALLAN PERRY MT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4636 PINE TREE DR
BOYNTON BEACH FL
33436-4823
US

IV. Provider business mailing address

4636 PINE TREE DR
BOYNTON BEACH FL
33436-4823
US

V. Phone/Fax

Practice location:
  • Phone: 561-736-8851
  • Fax:
Mailing address:
  • Phone: 561-736-8851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License NumberSU5645
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: