Healthcare Provider Details

I. General information

NPI: 1346462496
Provider Name (Legal Business Name): CHRISTOPHER A PERRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 THREE LAKES PKWY STE 100
TYLER TX
75703-0642
US

IV. Provider business mailing address

PO BOX 591819
SAN ANTONIO TX
78259-0140
US

V. Phone/Fax

Practice location:
  • Phone: 903-747-4050
  • Fax: 903-747-4075
Mailing address:
  • Phone: 830-328-4206
  • Fax: 210-966-9106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA117254
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number125-051674
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberQ7259
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: