MEDICARE: PERRY JC MD PA

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	208VP0014X	Interventional Pain Medicine Physician	ME83999	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0014P	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	614424600	OTHER	FL	OWCP - FECA
4	7511404	OTHER	FL	AETNA

General Provider Information

NPI Number	:	1457587891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERRY JC MD PA

Provider Business Mailing Address
First Line	:	PO BOX 3123
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32085-3123
Country	:	US
Telephone Number	:	904-824-4990
Fax Number	:	904-824-2226

Provider Business Practice Location Address
First Line	:	7999 PHILIPS HWY
Second Line	:	STE 302
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-4443
Country	:	US
Telephone Number	:	904-733-0099
Fax Number	:	904-733-0070

Authorized Official
Title or Position	:	OWNER
Name	:	PERRY J COLE
Credential	:	MD
Telephone Number	:	904-733-0099

Provider Enumeration Date	:	05/29/2009
Last Update Date	:	05/27/2011

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Directions to “PERRY JC MD PA ” Practice Location

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