Provider Demographics
NPI:1174591275
Name:PERRA, JEROME J (MD)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:J
Last Name:PERRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:710 COMMERCE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4925
Mailing Address - Country:US
Mailing Address - Phone:651-968-5042
Mailing Address - Fax:651-968-5904
Practice Address - Street 1:1285 NININGER RD
Practice Address - Street 2:SUITE 107
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-1086
Practice Address - Country:US
Practice Address - Phone:651-842-5412
Practice Address - Fax:651-437-2988
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2015-06-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN38049207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN200001995Medicare PIN
MNP00013175OtherRAILROAD MEDICARE
MN594818500Medicaid
MNG08304Medicare UPIN