Provider Demographics
NPI:1104844786
Name:PERRY, DEWAYDE (MD)
Entity type:Individual
Prefix:
First Name:DEWAYDE
Middle Name:
Last Name:PERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1769 PROVINCIAL WAY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6994
Mailing Address - Country:US
Mailing Address - Phone:541-255-3205
Mailing Address - Fax:888-864-3381
Practice Address - Street 1:1401 MARKET ST # B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3337
Practice Address - Country:US
Practice Address - Phone:541-255-3205
Practice Address - Fax:888-864-3381
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD27847208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC291259Medicaid