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General NPI Number Information
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NPI Number | 1194125161
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Entity Type | Organization
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Legal Business Name | RUSSELL PERRY, MD, PA
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Dates
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Enumeration Date | 08/27/2014
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 205 N 11TH ST
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City | BEAUMONT
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State | TX
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Zip | 77702-2213
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Country | US
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Telephone | 409-892-7090
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Fax | 409-892-4324
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Provider Business Mailing Address
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Address Line | 205 N 11TH ST
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City | BEAUMONT
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State | TX
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Zip | 77702-2213
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Country | US
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Telephone | 409-892-7090
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Fax | 409-892-4324
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | PATRICIA JANE GUILBEAUX
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Credential |
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Telephone | 409-892-7090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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