Basic Information
| Provider Information | |||||||||
| NPI: | 1639304942 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERRY | ||||||||
| FirstName: | DWAN | ||||||||
| MiddleName: | ROZZEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2050 VERSAILLES RD | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405041405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592574888 | ||||||||
| FaxNumber: | 8593231123 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 S LIMESTONE STREET SUITE A100A | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405368202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592572573 | ||||||||
| FaxNumber: | 8593230096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2009 | ||||||||
| LastUpdateDate: | 09/27/2018 | ||||||||
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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 | 207QS0010X | 0102203436 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 2081S0010X | TP990 | KY | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine | 2081S0010X | 2736 | TN | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine | 2081S0010X | 0102203436 | VA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine | 2081S0010X | 04197 | KY | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine |
No ID Information.