MEDICARE: DR. KEITH LOU ANTHONY PERKINS JR. M.D.

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
1	207R00000X	Internal Medicine Physician	46862	TN
2	208000000X	Pediatrics Physician	46862	TN

General Provider Information

NPI Number	:	1225253883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH LOU ANTHONY PERKINS JR. M.D.

Provider Business Mailing Address
First Line	:	63 GRANDVIEW LOOP
Second Line	:
City	:	SELMER
State	:	TN
Zip	:	38375-4607
Country	:	US
Telephone Number	:	314-541-2860
Fax Number	:	731-540-9103

Provider Business Practice Location Address
First Line	:	714 FEDERAL DR
Second Line	:
City	:	SELMER
State	:	TN
Zip	:	38375-1876
Country	:	US
Telephone Number	:	731-540-9083
Fax Number	:	731-540-9103

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	03/30/2023

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