Individual
PERRY D MALEARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-2829
(417) 820-8852
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2012026924
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356698799
—
MO
05
—
193949001
—
AR
01
—
431560263
TRICARE
MO
01
—
P01094284
RR MCR
MO
Enumeration date
08/03/2012
Last updated
12/12/2012
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