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 |
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 | |||||||||||||||||||||
|
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 |
Name | Role | Address |
---|---|---|
PERRY, RUSSELL E | Agent | 406 PALMETTO STREET SUITE A, NEW SMYRNA BEACH, FL 32168 |
Name | Role | Address |
---|---|---|
PERRY, RUSSELL E | Director | 406 PALMETTO ST SUITE A, NEW SMYRNA BCH, FL 32168 |
Name | Role | Address |
---|---|---|
PERRY, RUSSELL E | Manager | 406 PALMETTO ST SUITE A, NEW SMYRNA BCH, FL 32168 |
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 |
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