Basic Information
| Provider Information | |||||||||
| NPI: | 1083800999 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERRYMAN | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | VERNON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 651 1ST ST W | ||||||||
| Address2: | STE K | ||||||||
| City: | SONOMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954767045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7079383870 | ||||||||
| FaxNumber: | 7079383076 | ||||||||
| Practice Location | |||||||||
| Address1: | 651 1ST ST W | ||||||||
| Address2: | STE K | ||||||||
| City: | SONOMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954767045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7079383870 | ||||||||
| FaxNumber: | 7079383076 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2007 | ||||||||
| LastUpdateDate: | 02/20/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | A85617 | CA | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.