Healthcare Provider Details

I. General information

NPI: 1912445438
Provider Name (Legal Business Name): TERRY JONATHAN PERKINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 DE LA VINA ST STE 101
SANTA BARBARA CA
93105-3878
US

IV. Provider business mailing address

2323 DE LA VINA ST STE 101
SANTA BARBARA CA
93105-3878
US

V. Phone/Fax

Practice location:
  • Phone: 805-563-0000
  • Fax: 805-563-9746
Mailing address:
  • Phone: 805-563-0000
  • Fax: 805-563-9746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberG030406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: