Basic Information
Provider Information
NPI: 1033557418
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PERRY
FirstName: WILLIAM
MiddleName: PATTON
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 102 MASON FARM RD
Address2: ACC CLINIC, CB# 7705
City: CHAPEL HILL
State: NC
PostalCode: 275990001
CountryCode: US
TelephoneNumber: 9199661459
FaxNumber: 9199669355
Practice Location
Address1: 102 MASON FARM RD
Address2: ACC CLINIC, CB# 7705
City: CHAPEL HILL
State: NC
PostalCode: 275990001
CountryCode: US
TelephoneNumber: 9199661459
FaxNumber: 9199669355
Other Information
ProviderEnumerationDate: 06/07/2013
LastUpdateDate: 06/07/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X191875NCY Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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