Healthcare Provider Details

I. General information

NPI: 1104228048
Provider Name (Legal Business Name): PERRY R LLOYD III MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 SUNRISE BLVD
FORT PIERCE FL
34950-5366
US

IV. Provider business mailing address

2207 SUNRISE BLVD
FORT PIERCE FL
34950-5366
US

V. Phone/Fax

Practice location:
  • Phone: 772-465-0491
  • Fax:
Mailing address:
  • Phone: 772-465-0491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH LLOYD
Title or Position: OFFICE MANAGER
Credential:
Phone: 772-971-7451