MEDICARE: DR. GLENN BRADFORD 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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	26968	NC
2	207X00000X	Orthopaedic Surgery Physician	26968	NC

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	:	1588660716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN BRADFORD PERRY MD

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-358-0308
Fax Number	:	704-358-0039

Provider Business Practice Location Address
First Line	:	2826 RANDOLPH RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1019
Country	:	US
Telephone Number	:	704-358-0308
Fax Number	:	704-358-0039

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	03/12/2015

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