Healthcare Provider Details

I. General information

NPI: 1467930826
Provider Name (Legal Business Name): PERRY ORTHOPEDICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2018
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W HIBISCUS BLVD
MELBOURNE FL
32901-2615
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-500-5633
  • Fax: 321-617-5633
Mailing address:
  • Phone: 321-500-5633
  • Fax: 321-617-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME103032
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN JAY PERRY
Title or Position: CEO
Credential: MD
Phone: 321-500-5633