Healthcare Provider Details

I. General information

NPI: 1851408801
Provider Name (Legal Business Name): REX BEACH PERKINS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 COUNTY ROAD 57
GORDO AL
35466-3886
US

IV. Provider business mailing address

845 COUNTY ROAD 57
GORDO AL
35466-3886
US

V. Phone/Fax

Practice location:
  • Phone: 205-364-7589
  • Fax:
Mailing address:
  • Phone: 205-364-7589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7256
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: