Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 28724 | IA |
NPI | 1003803701 |
---|---|
Provider Name | Dr. Gina M Perri |
First Address | Cedar Rapids, IA 52406-1824 |
Second Address | Cedar Rapids, IA 52403-2450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2005 |
Last Update Date | 30/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3073171 | (05) | IA |