Healthcare Provider Details

I. General information

NPI: 1114924594
Provider Name (Legal Business Name): DONALD THOMAS PERRY C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 E GREENWOOD AVE
BOWIE TX
76230-3135
US

IV. Provider business mailing address

9423 VALLEY VIEW TRL FISHERMANS PARADISE
RIO VISTA TX
76093-3102
US

V. Phone/Fax

Practice location:
  • Phone: 940-872-9404
  • Fax:
Mailing address:
  • Phone: 817-556-9907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number026602
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: