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1730174038

NPI Code Detail

MEDICARE: PHIL C PERRY MD

MEDICARE: PHIL C 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	207L00000X	Anesthesiology Physician	ME46225	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	15980	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1730174038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHIL C PERRY MD

Provider Business Mailing Address
First Line	:	5102 YACHT CLUB RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-8324
Country	:	US
Telephone Number	:	904-387-5163
Fax Number	:	904-387-5651

Provider Business Practice Location Address
First Line	:	1 SHIRCLIFF WAY
Second Line	:	SUITE 1302
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4748
Country	:	US
Telephone Number	:	904-308-7420
Fax Number	:

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	03/10/2011

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Directions to “ PHIL C PERRY MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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