Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 10729 | MS |
NPI | 1093752297 |
---|---|
Provider Name | Dr. Kenneth Giles Perry JR. |
First Address | Jackson, MS 39202-1651 |
Second Address | Jackson, MS 39202-1651 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0120176 | (05) | MS |
4241432 | AETNA (01) | MS |
E91282 | (02) | MS |