Healthcare Provider Details

I. General information

NPI: 1104854660
Provider Name (Legal Business Name): BYRON LEONARD PERKINSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S ADAMS ST
NEVADA MO
64772-3210
US

IV. Provider business mailing address

800 S ASH ST
NEVADA MO
64772-3224
US

V. Phone/Fax

Practice location:
  • Phone: 417-667-6015
  • Fax: 417-448-8970
Mailing address:
  • Phone: 417-667-3355
  • Fax: 417-667-4234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number81270
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number72315
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2023044254
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: