Provider Demographics
NPI:1154316107
Name:PERAUD, MARY SHARON (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:SHARON
Last Name:PERAUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:115 SCHULT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50630-9582
Mailing Address - Country:US
Mailing Address - Phone:563-237-5316
Mailing Address - Fax:563-237-6337
Practice Address - Street 1:115 SCHULT RIDGE RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:IA
Practice Address - Zip Code:50630-9582
Practice Address - Country:US
Practice Address - Phone:563-237-5316
Practice Address - Fax:563-237-6337
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA19386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA13038OtherBCBS
IA7882OtherMIDLANDS CHOICE
IA0130385Medicaid
IA2313560OtherUNITED HEALTH CARE
IAAO1155Medicare UPIN
IA13038Medicare PIN