Healthcare Provider Details

I. General information

NPI: 1275596470
Provider Name (Legal Business Name): JOHN W PERRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 MERCY DR NW STE 101
CANTON OH
44708-2624
US

IV. Provider business mailing address

1320 MERCY DR NW
CANTON OH
44708-2614
US

V. Phone/Fax

Practice location:
  • Phone: 330-588-4676
  • Fax: 330-588-4677
Mailing address:
  • Phone: 330-489-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number23451
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number35.075387
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: