Healthcare Provider Details

I. General information

NPI: 1548214141
Provider Name (Legal Business Name): KEITH A PERRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CEDAR SWAMP RD
SMITHFIELD RI
02917-2448
US

IV. Provider business mailing address

14 CEDAR SWAMP RD
SMITHFIELD RI
02917-2448
US

V. Phone/Fax

Practice location:
  • Phone: 401-231-0060
  • Fax: 401-231-0064
Mailing address:
  • Phone: 401-231-0060
  • Fax: 401-231-0064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD07817
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD07817
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: