MEDICARE: PERRI DERMATOLOGY, PLLC INC

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
1	207N00000X	Dermatology Physician	M6826	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174885925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERRI DERMATOLOGY, PLLC INC

Provider Business Mailing Address
First Line	:	4015 INTERSTATE 45 N STE 200
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-5076
Country	:	US
Telephone Number	:	936-522-4966
Fax Number	:

Provider Business Practice Location Address
First Line	:	4015 INTERSTATE 45 N STE 200
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-5076
Country	:	US
Telephone Number	:	936-522-4966
Fax Number	:	936-522-4998

Authorized Official
Title or Position	:	OWNER
Name	:	ANTHONY JOSEPH PERRI III
Credential	:	M.D.
Telephone Number	:	936-522-4966

Provider Enumeration Date	:	06/07/2012
Last Update Date	:	09/01/2023

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