Provider Demographics
NPI:1265757041
Name:PERRY W, SEXTON, MD PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:PERRY W, SEXTON, MD PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:SEXTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-274-1385
Mailing Address - Street 1:351 SANTA FE DR
Mailing Address - Street 2:101
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5137
Mailing Address - Country:US
Mailing Address - Phone:760-274-1385
Mailing Address - Fax:760-274-1388
Practice Address - Street 1:351 SANTA FE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5137
Practice Address - Country:US
Practice Address - Phone:760-274-1385
Practice Address - Fax:760-274-1388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94937207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADF002AMedicare UPIN