Healthcare Provider Details

I. General information

NPI: 1922111541
Provider Name (Legal Business Name): MALCOLM O PERRY III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W BETHANY DR STE 360
ALLEN TX
75013-3837
US

IV. Provider business mailing address

950 W BETHANY DR STE 360
ALLEN TX
75013-3837
US

V. Phone/Fax

Practice location:
  • Phone: 469-854-6116
  • Fax:
Mailing address:
  • Phone: 469-854-6116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberJ1476
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: