Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | D0031408 | MD |
Y | 207QA0401X | Family Doctor - Addiction Medicine | D0031408 | MD |
NPI | 1710930805 |
---|---|
Provider Name | Richard Grover Perry |
First Address | Oakland, MD 21550-1513 |
Second Address | Oakland, MD 21550-1513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
364831100 | (05) | MD |
C88054 | (02) |