MEDICARE: DR. PAUL G PERCH 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	208600000X	Surgery Physician	A82121	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A821210	OTHER	CA	MEDICAL

General Provider Information

NPI Number	:	1558396705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL G PERCH MD

Provider Business Mailing Address
First Line	:	1526 N EDGEMONT ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5260
Country	:	US
Telephone Number	:	323-783-4595
Fax Number	:	323-783-6134

Provider Business Practice Location Address
First Line	:	1526 N EDGEMONT ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5260
Country	:	US
Telephone Number	:	323-783-4595
Fax Number	:

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	11/29/2021

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