=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104854660
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BYRON LEONARD PERKINSON M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2006
-----------------------------------------------------
Last Update Date | 10/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 S ADAMS ST
-----------------------------------------------------
City | NEVADA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64772-3210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-667-6015
-----------------------------------------------------
Fax | 417-448-8970
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 S ASH ST
-----------------------------------------------------
City | NEVADA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64772-3224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-667-3355
-----------------------------------------------------
Fax | 417-667-4234
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 81270
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 72315
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 2023044254
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------