Healthcare Provider Details

I. General information

NPI: 1598786105
Provider Name (Legal Business Name): TEDDY BEAR OBSTETRICS & GYNECOLOGY PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 S AUBURN ST SUITE P
KENNEWICK WA
99336-5665
US

IV. Provider business mailing address

711 S AUBURN ST SUITE P
KENNEWICK WA
99336-5665
US

V. Phone/Fax

Practice location:
  • Phone: 509-582-0400
  • Fax: 509-582-0408
Mailing address:
  • Phone: 509-582-0400
  • Fax: 509-582-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number00025747
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number00025747
License Number StateWA

VIII. Authorized Official

Name: DR. JOHN CHRISTIAN PERRY
Title or Position: OWNER
Credential: M.D.
Phone: 509-582-0400