MEDICARE: DR. FREDERICK BRUCE PERRY D.O.

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	207P00000X	Emergency Medicine Physician		IA

General Provider Information

NPI Number	:	1811073109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK BRUCE PERRY D.O.

Provider Business Mailing Address
First Line	:	1012 S HIGH ST
Second Line	:
City	:	PORT BYRON
State	:	IL
Zip	:	61275-9307
Country	:	US
Telephone Number	:	563-529-4411
Fax Number	:

Provider Business Practice Location Address
First Line	:	1012 S HIGH ST
Second Line	:
City	:	PORT BYRON
State	:	IL
Zip	:	61275-9307
Country	:	US
Telephone Number	:	563-529-4411
Fax Number	:

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

Provider Enumeration Date	:	10/28/2006
Last Update Date	:	07/08/2007

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