MEDICARE: DR. GARY R. PERRIN, P.A.

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	251S00000X	Community/Behavioral Health Agency	LP 305	MN

General Provider Information

NPI Number	:	1376813584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. GARY R. PERRIN, P.A.

Provider Business Mailing Address
First Line	:	527 MARQUETTE AVE
Second Line	:	STE. 1620
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55402-1302
Country	:	US
Telephone Number	:	612-317-0665
Fax Number	:	612-317-1017

Provider Business Practice Location Address
First Line	:	527 MARQUETTE AVE
Second Line	:	STE. 1620
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55402-1302
Country	:	US
Telephone Number	:	612-317-0665
Fax Number	:	612-317-1017

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GARY RAY PERRIN
Credential	:	PHD, LP
Telephone Number	:	612-317-0665

Provider Enumeration Date	:	01/04/2012
Last Update Date	:	01/04/2012

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