Susan Barbara Perry, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

24610 Issued in IA

Practice address

2535 Maplecrest Rd
Suite 20
Bettendorf, IA 52722-7709

Phone

(563) 332-1500

Fax

(563) 332-1005

NPI assigned

Jul 14, 2005

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1497754295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2535 MAPLECREST RD",
            "address_2": "SUITE 20",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527227709",
            "telephone_number": "563-332-1500",
            "fax_number": "563-332-1005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2535 MAPLECREST RD",
            "address_2": "SUITE 20",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527227709",
            "telephone_number": "563-332-1500",
            "fax_number": "563-332-1005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERRY",
        "first_name": "SUSAN",
        "middle_name": "BARBARA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-07-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IA",
            "license": "24610",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IA",
            "license": "4301044740",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BCBS",
            "identifier": "22233",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0222331",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paul R Black DDS PC
• Rachel Paulsen, DPT
• Laura Paxton
• Lori Ann Pedersen, LISW, MAPC
• Sunita Kammila Penmatcha, M.D.
• Ryan Babu Perumpail, M.D.
• Daniel Petefish, PHARMD
• Elizabeth Grace Peters, MA,CCC-SLP
• Joseph Conner Peters, OD
• Olivia Anna Peters, PA-C

• Dermatology Physician in Bettendorf, IA
• Providers in Bettendorf, IA by specialty
• Dermatology Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.