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NPI Code Detail

MEDICARE: DAVID W. PERDUE JR. PA-C

MEDICARE: DAVID W. PERDUE JR. PA-C
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 Assistant295WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1001836147OTHERWVBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
31070558OTHERBRICKSTREET
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174547442
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID W. PERDUE JR. PA-C
Provider Business Mailing Address
First Line : 122 12TH ST
Second Line :
City : PRINCETON
State : WV
Zip : 24740-2312
Country : US
Telephone Number : 304-487-7726
Fax Number : 304-431-5263
Provider Business Practice Location Address
First Line : 122 12TH ST
Second Line :
City : PRINCETON
State : WV
Zip : 24740-2312
Country : US
Telephone Number : 304-487-7726
Fax Number : 304-431-5263
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 08/28/2015

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Directions to “ DAVID W. PERDUE JR. PA-C” Practice Location

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