Provider Demographics
NPI:1992787246
Name:PERRY, ROBERT WAYNE II (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WAYNE
Last Name:PERRY
Suffix:II
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-1198
Mailing Address - Country:US
Mailing Address - Phone:765-932-4111
Mailing Address - Fax:765-932-7505
Practice Address - Street 1:110 E 13TH ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173-2126
Practice Address - Country:US
Practice Address - Phone:765-932-7023
Practice Address - Fax:765-932-7024
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY44761207V00000X
IN01041810A207VG0400X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100381710BMedicaid
IN040770OtherSIHO
OH0054872Medicaid
IN100381710BMedicaid
IN100381710BMedicaid
KY7100189660Medicaid
F85991Medicare UPIN