Healthcare Provider Details

I. General information

NPI: 1689682528
Provider Name (Legal Business Name): CRYSTAL L. PERRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 11/27/2023
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 BROADWAY ST SUITE 120
QUINCY IL
62301-2719
US

IV. Provider business mailing address

927 BROADWAY ST SUITE 120
QUINCY IL
62301-2719
US

V. Phone/Fax

Practice location:
  • Phone: 217-224-6423
  • Fax: 217-228-3251
Mailing address:
  • Phone: 217-224-6423
  • Fax: 217-228-3251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number036-098493
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-098493
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: