Healthcare Provider Details

I. General information

NPI: 1538664925
Provider Name (Legal Business Name): JENNIFER PERRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 PAN AMERICAN EAST FWY NE STE 200
ALBUQUERQUE NM
87109-3443
US

IV. Provider business mailing address

6100 PAN AMERICAN EAST FWY NE STE 200
ALBUQUERQUE NM
87109-3443
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-8282
  • Fax: 505-823-8275
Mailing address:
  • Phone: 505-823-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2021-0537
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: