Healthcare Provider Details

I. General information

NPI: 1932202223
Provider Name (Legal Business Name): DR. TERRY DON PERKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 SAGEBRIAR DRIVE
BRYAN TX
77802-6107
US

IV. Provider business mailing address

911 GREENBRANCH LOOP
BRYAN TX
77808
US

V. Phone/Fax

Practice location:
  • Phone: 979-774-0498
  • Fax:
Mailing address:
  • Phone: 979-776-9040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberJ8711
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: