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General NPI Number Information
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NPI Number | 1215904289
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Entity Type | Individual
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Provider Name | MARK ANTHONY PERKINS LSA
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Gender | Male
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 08/11/2010
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Provider Practice Location Address
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Address Line | 3245 W MAIN ST SUITE 235-182
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City | FRISCO
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State | TX
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Zip | 75034-4411
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Country | US
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Telephone | 214-733-2789
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Fax | 215-436-5495
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Provider Business Mailing Address
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Address Line | 3245 W MAIN ST SUITE 235-182
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City | FRISCO
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State | TX
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Zip | 75034-4411
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Country | US
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Telephone | 214-733-2789
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Fax | 215-436-5495
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | SA00349
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License Number State | TX
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