Healthcare Provider Details

I. General information

NPI: 1619081387
Provider Name (Legal Business Name): THEODORE G PERRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3745 11TH CIR STE 101
VERO BEACH FL
32960-4838
US

IV. Provider business mailing address

3745 11TH CIR STE 101
VERO BEACH FL
32960-4838
US

V. Phone/Fax

Practice location:
  • Phone: 772-589-0580
  • Fax:
Mailing address:
  • Phone: 772-589-0580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME58748
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: