Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 02739-L | PA |
NPI | 1114012721 |
---|---|
Provider Name | John Perri |
First Address | Pittsburgh, PA 15240-1004 |
Second Address | Pittsburgh, PA 15240-1004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |