Basic Information
| Provider Information | |||||||||
| NPI: | 1023004223 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERRY | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 W GLEN ST | ||||||||
| Address2: | |||||||||
| City: | CRANDON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 545201355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7154783318 | ||||||||
| FaxNumber: | 7154783255 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 W GLEN ST | ||||||||
| Address2: | |||||||||
| City: | CRANDON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 545201355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7154783318 | ||||||||
| FaxNumber: | 7154783255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2005 | ||||||||
| LastUpdateDate: | 05/08/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 22328 | WI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.