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NPI Code Detail

MEDICARE: REBECCA D PERRY MD

MEDICARE: REBECCA D PERRY MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician22328WI

General Provider Information

NPI Number : 1023004223
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA D PERRY MD
Provider Business Mailing Address
First Line : 400 W GLEN ST
Second Line :
City : CRANDON
State : WI
Zip : 54520-1355
Country : US
Telephone Number : 715-478-3318
Fax Number : 715-478-3255
Provider Business Practice Location Address
First Line : 400 W GLEN ST
Second Line :
City : CRANDON
State : WI
Zip : 54520-1355
Country : US
Telephone Number : 715-478-3318
Fax Number : 715-478-3255
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2005
Last Update Date : 05/08/2012

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