Individual
DR. TRALE BARRY PERMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1003 WILLOW CREEK RD, PRESCOTT, AZ 86301-1641
(928) 445-2700
Mailing address
4440 W 95TH ST, OAK LAWN, IL 60453-2600
(708) 684-5375
(708) 684-1028
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
50200
AZ
390200000X
Student in an Organized Health Care Education/Training Program
125061067
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Z179265
MEDICARE
AZ
Enumeration date
06/26/2012
Last updated
09/08/2015
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