MEDICARE: DR. RAYMOND 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
1	208000000X	Pediatrics Physician	125050815	IL
2	208000000X	Pediatrics Physician	A107565	CA

General Provider Information

NPI Number	:	1932376274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND PERRY M.D.

Provider Business Mailing Address
First Line	:	911 BROXTON AVE
Second Line	:	3RD FLOOR
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-2801
Country	:	US
Telephone Number	:	310-794-2904
Fax Number	:	310-794-3288

Provider Business Practice Location Address
First Line	:	911 BROXTON AVE
Second Line	:	3RD FLOOR
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-2801
Country	:	US
Telephone Number	:	310-794-2904
Fax Number	:	310-794-3288

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

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	08/26/2010

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