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NPI Code Detail

MEDICARE: DR. ARCHIE CHARLES PERRY JR. M.D.

MEDICARE:  DR. ARCHIE CHARLES PERRY JR. M.D.
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
1207XS0117XOrthopaedic Surgery of the Spine Physician42033NV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4P00142405OTHERR.R. MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CC6778OTHERBXBS
27499443OTHERAETNA
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245218510
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ARCHIE CHARLES PERRY JR. M.D.
Provider Business Mailing Address
First Line : 2800 E DESERT INN RD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-3609
Country : US
Telephone Number : 702-731-1616
Fax Number : 702-734-4900
Provider Business Practice Location Address
First Line : 2800 E DESERT INN RD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-3609
Country : US
Telephone Number : 702-731-1616
Fax Number : 702-734-4900
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2006
Last Update Date : 10/11/2018

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Directions to “ DR. ARCHIE CHARLES PERRY JR. M.D.” Practice Location

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