Healthcare Provider Details

I. General information

NPI: 1518257666
Provider Name (Legal Business Name): JASON PERRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3313 W HILLSBORO BLVD
DEERFIELD BEACH FL
33442-9423
US

IV. Provider business mailing address

33 E CAMINO REAL APT 331
BOCA RATON FL
33432-6149
US

V. Phone/Fax

Practice location:
  • Phone: 954-571-9500
  • Fax: 954-571-9560
Mailing address:
  • Phone: 954-547-0088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberME124182
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: