Healthcare Provider Details

I. General information

NPI: 1417043696
Provider Name (Legal Business Name): ERNEST B PERKINS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 STANLEY ROAD
CLAYTON OK
74536
US

IV. Provider business mailing address

109 STANLEY ROAD
CLAYTON OK
74536
US

V. Phone/Fax

Practice location:
  • Phone: 918-569-4143
  • Fax: 918-569-4305
Mailing address:
  • Phone: 918-569-4143
  • Fax: 918-569-4305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA470
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: