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NPI Code Detail

MEDICARE: DR. ROD W PERRY M.D.

MEDICARE: DR. ROD W PERRY M.D.
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
1174400000XSpecialistG33909CA

General Provider Information

NPI Number : 1629170956
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROD W PERRY M.D.
Provider Business Mailing Address
First Line : 365 HAWTHORNE AVE
Second Line : SUITE 202
City : OAKLAND
State : CA
Zip : 94609-3114
Country : US
Telephone Number : 510-419-0211
Fax Number : 510-419-0140
Provider Business Practice Location Address
First Line : 365 HAWTHORNE AVE
Second Line : SUITE 202
City : OAKLAND
State : CA
Zip : 94609-3114
Country : US
Telephone Number : 510-419-0211
Fax Number : 510-419-0140
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2006
Last Update Date : 04/09/2014

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