Healthcare Provider Details

I. General information

NPI: 1285624874
Provider Name (Legal Business Name): JOHN B PERRY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 CONGRESS ST
PORTLAND ME
04102-1962
US

IV. Provider business mailing address

1711 CONGRESS ST
PORTLAND ME
04102-1962
US

V. Phone/Fax

Practice location:
  • Phone: 207-773-5800
  • Fax:
Mailing address:
  • Phone: 207-773-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD237
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: