Provider Demographics
NPI:1427101187
Name:PERRY, JOHN LOUIS JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LOUIS
Last Name:PERRY
Suffix:JR
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 1:150 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3320
Mailing Address - Country:US
Mailing Address - Phone:310-519-6100
Mailing Address - Fax:
Practice Address - Street 1:150 W 7TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3320
Practice Address - Country:US
Practice Address - Phone:310-519-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA643942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH51474Medicare UPIN
CADR299XMedicare PIN