Basic Information
| Provider Information | |||||||||
| NPI: | 1275596470 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERRY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1320 MERCY DR NW | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447082614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304891111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1330 MERCY DR NW STE 101 | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447082624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305884676 | ||||||||
| FaxNumber: | 3305884677 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 06/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | 23451 | SC | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | 35.075387 | OH | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 2179673 | 01 | OH | OH MEDICAID MOLINA | OTHER | 3810011193 | 05 | WV | MEDICAID | 310917085181 | 01 | OH | OH MEDICAID CARESOURCE | OTHER | 2179673 | 05 | OH | MEDICAID | 000000235300 | 01 | OH | OH MEDICAID UNISON | OTHER |