Provider Demographics
NPI:1528064821
Name:PERRY, BOBBY DEAN (MD)
Entity type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:DEAN
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 1:701 N UNIVERSITY AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2936
Mailing Address - Country:US
Mailing Address - Phone:501-664-2434
Mailing Address - Fax:501-907-7768
Practice Address - Street 1:701 N UNIVERSITY AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2936
Practice Address - Country:US
Practice Address - Phone:501-664-2434
Practice Address - Fax:501-907-7768
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2015-06-02
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-07
Provider Licenses
StateLicense IDTaxonomies
ARC7732174400000X
ARC-7732208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR125279001Medicaid
ARF81151Medicare UPIN
AR5J426Medicare PIN