Healthcare Provider Details

I. General information

NPI: 1518906312
Provider Name (Legal Business Name): JOHN PERL II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 E BANNOCK
BOISE ID
83712
US

IV. Provider business mailing address

2686 E WINDSONG DR
BOISE ID
83712-5010
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-2094
  • Fax: 208-381-1791
Mailing address:
  • Phone: 612-863-1044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number45089
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: