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RUSSELL E. PERRY, M.D., P.A

Company Details

Entity Name: RUSSELL E. PERRY, M.D., P.A
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Inactive
Date Filed: 23 Jul 1981 (44 years ago)
Date of dissolution: 18 Feb 2013 (12 years ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 18 Feb 2013 (12 years ago)
Document Number: 695810
FEI/EIN Number 59-2109362
Address: 406 PALMETTO STREET SUITE A, NEW SMYRNA BEACH, FL 32168
Mail Address: 406 PALMETTO STREET SUITE A, NEW SMYRNA BEACH, FL 32168
ZIP code: 32168
County: Volusia
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1144417387 2007-10-02 2010-01-28 406 PALMETTO ST STE A, NEW SMYRNA BEACH, FL, 321687323, US 406 PALMETTO ST STE A, NEW SMYRNA BEACH, FL, 321687323, US

Contacts

Phone +1 386-423-1212
Fax 3864235730

Authorized person

Name ROXANN PERRY
Role OFFICE MANAGER
Phone 3864231212

Taxonomy

Taxonomy Code 207R00000X - Internal Medicine Physician
Is Primary Yes

Other Provider Identifiers

Issuer BCBS
Number 64384
State FL

Agent

Name Role Address
PERRY, RUSSELL E Agent 406 PALMETTO STREET SUITE A, NEW SMYRNA BEACH, FL 32168

Director

Name Role Address
PERRY, RUSSELL E Director 406 PALMETTO ST SUITE A, NEW SMYRNA BCH, FL 32168

Manager

Name Role Address
PERRY, RUSSELL E Manager 406 PALMETTO ST SUITE A, NEW SMYRNA BCH, FL 32168

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2013-02-18 No data No data
CANCEL ADM DISS/REV 2006-10-17 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2006-09-15 No data No data
REGISTERED AGENT ADDRESS CHANGED 2005-01-07 406 PALMETTO STREET SUITE A, NEW SMYRNA BEACH, FL 32168 No data
CHANGE OF PRINCIPAL ADDRESS 1991-02-22 406 PALMETTO STREET SUITE A, NEW SMYRNA BEACH, FL 32168 No data
CHANGE OF MAILING ADDRESS 1991-02-22 406 PALMETTO STREET SUITE A, NEW SMYRNA BEACH, FL 32168 No data

Documents

Name Date
Voluntary Dissolution 2013-02-18
ANNUAL REPORT 2012-01-09
ANNUAL REPORT 2011-01-04
ANNUAL REPORT 2010-01-19
ANNUAL REPORT 2009-01-05
ANNUAL REPORT 2008-01-07
ANNUAL REPORT 2007-05-03
REINSTATEMENT 2006-10-17
ANNUAL REPORT 2005-01-07
ANNUAL REPORT 2004-04-07

Date of last update: 05 Feb 2025

Sources: Florida Department of State