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NPI Code Detail

MEDICARE: BRENT L PERKINS PA

MEDICARE:   BRENT L PERKINS  PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant100328NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00395334OTHERNCRAILROAD MEDICARE

General Provider Information

NPI Number : 1124035928
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENT L PERKINS PA
Provider Business Mailing Address
First Line : PO BOX 4238
Second Line :
City : CALABASH
State : NC
Zip : 28467-9820
Country : US
Telephone Number : 910-575-6538
Fax Number : 910-575-6541
Provider Business Practice Location Address
First Line : 10195 BEACH DR SW # 5
Second Line :
City : CALABASH
State : NC
Zip : 28467-2701
Country : US
Telephone Number : 910-575-6538
Fax Number : 910-575-6541
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2006
Last Update Date : 05/02/2008

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Directions to “ BRENT L PERKINS PA” Practice Location

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