Healthcare Provider Details

I. General information

NPI: 1386731719
Provider Name (Legal Business Name): CLINT E. PERMAN P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 MAIN ST
SELBY SD
57472-2010
US

IV. Provider business mailing address

PO BOX 556
BOWDLE SD
57428-0556
US

V. Phone/Fax

Practice location:
  • Phone: 605-649-9999
  • Fax:
Mailing address:
  • Phone: 605-285-6832
  • Fax: 605-285-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0505
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: