Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | G9297 | TX |
NPI | 1003899113 |
---|---|
Provider Name | Paul Bryan Perry |
First Address | Dallas, TX 75209-2004 |
Second Address | Dallas, TX 75209-2004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 23/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
120167501 | (05) | TX |
C20422 | (02) |