Provider Demographics
NPI:1285624874
Name:PERRY, JOHN B (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:PERRY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-1962
Mailing Address - Country:US
Mailing Address - Phone:207-773-5800
Mailing Address - Fax:
Practice Address - Street 1:1711 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1962
Practice Address - Country:US
Practice Address - Phone:207-773-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD237213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MELX5420Medicare PIN
U32735Medicare UPIN
MEMM4347Medicare PIN