Provider Demographics
NPI:1871562645
Name:PERRY, RICHARD CLARK (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:CLARK
Last Name:PERRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8205 E 56TH STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216
Practice Address - Country:US
Practice Address - Phone:317-621-4044
Practice Address - Fax:317-621-4050
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001843A207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200234480Medicaid
IN5454033OtherAETNA
INP00999138OtherMEDICARE RR
IN000000639913OtherANTHEM
IN000000639913OtherANTHEM
INP00999138OtherMEDICARE RR
IN200234480Medicaid