Provider Demographics
NPI:1356721005
Name:PERRY, CHRISTOPHER DALE (INDEPENDENT DUTY COR)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DALE
Last Name:PERRY
Suffix:
Gender:M
Credentials:INDEPENDENT DUTY COR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 S KEARSLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-2045
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3332 S KEARSLEY BLVD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-2045
Practice Address - Country:US
Practice Address - Phone:207-522-9853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman