Provider Demographics
NPI:1962409326
Name:PERRY, JOHN CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHRISTOPHER
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 LUKE ST STE D
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-9680
Mailing Address - Country:US
Mailing Address - Phone:252-482-6522
Mailing Address - Fax:
Practice Address - Street 1:701 LUKE ST
Practice Address - Street 2:STE D
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-9680
Practice Address - Country:US
Practice Address - Phone:252-482-6522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26142207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8966982Medicaid
NC26142OtherSTATE LICENSE
NC66982OtherBCBS
NC66982OtherBCBS
NCAP9324005OtherDEA #
NC8966982Medicaid