Basic Information
| Provider Information | |||||||||
| NPI: | 1861404402 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERRY | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 TOY TOWN LN | ||||||||
| Address2: | |||||||||
| City: | WINCHENDON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014752801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782972809 | ||||||||
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| Practice Location | |||||||||
| Address1: | 242 GREEN ST | ||||||||
| Address2: | |||||||||
| City: | GARDNER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014401336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786323420 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 01/21/2010 | ||||||||
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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 | 207Q00000X | 228894 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.