Basic Information
| Provider Information | |||||||||
| NPI: | 1407071558 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERRY | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2005 | ||||||||
| Address2: | |||||||||
| City: | ASHEBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272042005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366251172 | ||||||||
| FaxNumber: | 3366256434 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 N COX ST STE 28 | ||||||||
| Address2: | |||||||||
| City: | ASHEBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366296500 | ||||||||
| FaxNumber: | 3366299500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2007 | ||||||||
| LastUpdateDate: | 07/30/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 173000000X | 24697 | NC | N | Other Service Providers | Legal Medicine | 207QG0300X | 24697 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | 207Q00000X | 24697 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8966985 | 05 | NC | MEDICAID |