Healthcare Provider Details

I. General information

NPI: 1437141983
Provider Name (Legal Business Name): JOHN ROBERT PERKINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W 3RD ST
ELK CITY OK
73644-5205
US

IV. Provider business mailing address

PO BOX 725
ELK CITY OK
73648-0725
US

V. Phone/Fax

Practice location:
  • Phone: 580-225-5900
  • Fax: 580-225-5901
Mailing address:
  • Phone: 580-225-5900
  • Fax: 580-225-5901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10570
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: