Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 1244 | TX |
NPI | 1346200649 |
---|---|
Provider Name | Dr. Jacquelyn Perry |
First Address | Fort Worth, TX 76111-4116 |
Second Address | Fort Worth, TX 76111-4116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 07/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00L64N | BLUE CROSS BLUE SHEILD (01) | TX |
018771801 | (05) | TX |
2097757 | AETNA HMO (01) | TX |
4407693 | AETNA PPO (01) | TX |
621526786 | PACIFICARE/SECURE HORIZON (01) | TX |
621526786 | PHCS (01) | TX |
621526786 | UNITED HEALTHCARE (01) | TX |
U42519 | (02) | TX |