Healthcare Provider Details

I. General information

NPI: 1598254435
Provider Name (Legal Business Name): JOHN PAUL PERKINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSC 10-6000 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

3140 HUNTER CREST DR
EDMOND OK
73034-0006
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2610
  • Fax:
Mailing address:
  • Phone: 580-821-0407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number39763
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: