Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | D42699 | MD |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | D42699 | MD |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | L1966 | TX |
NPI | 1437114402 |
---|---|
Provider Name | Mark Donald Perry |
First Address | Leonardtown, MD 20650-2916 |
Second Address | Leonardtown, MD 20650-2916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 12/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009910562 | (05) | AL |
009910563 | (05) | AL |
01471731 | (05) | MS |
144622102 | (05) | TX |
51541964 | BCBS - STANTON RD (01) | AL |
51541965 | BCBS- MEDICAL PARK DR (01) | AL |
F18057 | (02) |