Healthcare Provider Details

I. General information

NPI: 1407071558
Provider Name (Legal Business Name): LAWRENCE EDWARD PERRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N COX ST STE 28
ASHEBORO NC
27203
US

IV. Provider business mailing address

PO BOX 2005
ASHEBORO NC
27204-2005
US

V. Phone/Fax

Practice location:
  • Phone: 336-629-6500
  • Fax: 336-629-9500
Mailing address:
  • Phone: 336-625-1172
  • Fax: 336-625-6434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number24697
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number24697
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24697
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: