Healthcare Provider Details

I. General information

NPI: 1093825929
Provider Name (Legal Business Name): DEBORAH A PERRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8303 DODGE ST
OMAHA NE
68114-4108
US

IV. Provider business mailing address

PO BOX 2797
OMAHA NE
68103-2797
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-4540
  • Fax: 402-354-4535
Mailing address:
  • Phone: 402-354-4230
  • Fax: 402-354-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number17718
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number27781
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number17718
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number27781
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License Number17718
License Number StateNE
# 6
Primary TaxonomyN
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License Number27781
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: