Basic Information
| Provider Information | |||||||||
| NPI: | 1427316942 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERRY | ||||||||
| FirstName: | ALVIN | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3340 E GOLDSTONE WAY | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083022600 | ||||||||
| FaxNumber: | 2083022625 | ||||||||
| Practice Location | |||||||||
| Address1: | 999 N CURTIS ROAD | ||||||||
| Address2: | STE 415 | ||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083022600 | ||||||||
| FaxNumber: | 2083022625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2012 | ||||||||
| LastUpdateDate: | 01/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 036.152323 | IL | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | 036.152323 | IL | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0127X | 036.152323 | IL | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 208600000X | M-14120 | ID | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.