Provider Demographics
NPI:1366195976
Name:PERRY, MAURICE DANTWAN (PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:MAURICE
Middle Name:DANTWAN
Last Name:PERRY
Suffix:
Gender:M
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-3524
Mailing Address - Country:US
Mailing Address - Phone:904-609-2273
Mailing Address - Fax:
Practice Address - Street 1:2114 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-3524
Practice Address - Country:US
Practice Address - Phone:904-609-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22-0200246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy