MEDICARE: WENDELL C 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
1	208200000X	Plastic Surgery Physician	ME0081098	FL

General Provider Information

NPI Number	:	1275505687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDELL C PERRY MD

Provider Business Mailing Address
First Line	:	555 NE 15TH ST
Second Line	:	STE 12D
City	:	MIAMI
State	:	FL
Zip	:	33132
Country	:	US
Telephone Number	:	305-864-0013
Fax Number	:	305-864-0634

Provider Business Practice Location Address
First Line	:	1111 KANE CONCOURSE
Second Line	:	STE 511
City	:	BAY HARBOR ISLANDS
State	:	FL
Zip	:	33154
Country	:	US
Telephone Number	:	305-864-0013
Fax Number	:	305-864-0634

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	07/08/2007

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