MEDICARE: DR. JENNIFER 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	MD2021-0537	NM

General Provider Information

NPI Number	:	1538664925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER PERRY MD

Provider Business Mailing Address
First Line	:	6100 PAN AMERICAN EAST FWY NE STE 200
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-3443
Country	:	US
Telephone Number	:	505-823-8282
Fax Number	:

Provider Business Practice Location Address
First Line	:	6100 PAN AMERICAN EAST FWY NE STE 200
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-3443
Country	:	US
Telephone Number	:	505-823-8282
Fax Number	:	505-823-8275

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

Provider Enumeration Date	:	03/27/2018
Last Update Date	:	08/18/2021

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