MEDICARE: DR. PAUL R PERREAULT 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	207Q00000X	Family Medicine Physician	181806	NY

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	:	1487759270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL R PERREAULT MD

Provider Business Mailing Address
First Line	:	99 E STATE ST
Second Line	:	PO BOX 1250
City	:	GLOVERSVILLE
State	:	NY
Zip	:	12078-1203
Country	:	US
Telephone Number	:	518-661-5441
Fax Number	:	518-661-5452

Provider Business Practice Location Address
First Line	:	2497 STATE HIGHWAY 30
Second Line	:
City	:	MAYFIELD
State	:	NY
Zip	:	12117-3495
Country	:	US
Telephone Number	:	518-661-5441
Fax Number	:	518-661-5452

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	01/22/2015

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