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General NPI Number Information
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NPI Number | 1003878026
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Entity Type | Individual
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Provider Name | PETER PERRY P.A.-C
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Gender | Male
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Dates
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Enumeration Date | 04/05/2006
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Last Update Date | 08/07/2017
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Provider Practice Location Address
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Address Line | 1409 KINGSLEY AVE SUITE 6A
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City | ORANGE PARK
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State | FL
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Zip | 32073-4537
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Country | US
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Telephone | 904-264-7517
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Fax | 904-264-0015
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Provider Business Mailing Address
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Address Line | 7855 ARGYLE FOREST BLVD. STE. 101
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City | JACKSONVILLE
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State | FL
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Zip | 32244-5597
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Country | US
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Telephone | 904-282-6331
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Fax | 904-282-4117
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9103649
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License Number State | FL
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