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Individual

JOHNATHAN R PERRY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
6703 W RIO GRANDE AVE, KENNEWICK, WA 99336-2623
(509) 460-5588
(509) 783-5438
Mailing address
6703 W RIO GRANDE AVE, KENNEWICK, WA 99336-2623
(509) 460-5588
(509) 783-5438

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD00034127
WA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
MD00034127
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
246488
LABOR & INDUSTRIES
05
8403784
WA
01
P00815483
RR MEDICARE
WA
Enumeration date
11/11/2005
Last updated
07/16/2019
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