Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 42033 | NV |
NPI | 1245218510 |
---|---|
Provider Name | Dr. Archie Charles Perry JR. |
First Address | Las Vegas, NV 89121-3609 |
Second Address | Las Vegas, NV 89121-3609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 11/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1245218510 | (05) | NV |
7499443 | AETNA (01) | |
CC6778 | BXBS (01) | |
H02435 | (02) | |
P00142405 | R.R. MEDICARE (01) |