Healthcare Provider Details

I. General information

NPI: 1962409326
Provider Name (Legal Business Name): JOHN CHRISTOPHER PERRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 LUKE ST STE D
EDENTON NC
27932-9680
US

IV. Provider business mailing address

701 LUKE ST STE D
EDENTON NC
27932-9680
US

V. Phone/Fax

Practice location:
  • Phone: 252-482-6522
  • Fax:
Mailing address:
  • Phone: 252-482-6522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26142
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: