MEDICARE: THOMAS RANDOLPH 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	207Q00000X	Family Medicine Physician	00022846	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51504084	OTHER	AL	BLUE CROSS & BLUE SHIELD
2	01D0888565	OTHER	AL	CLIA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245244391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS RANDOLPH PERKINS JR. M.D.

Provider Business Mailing Address
First Line	:	2834 MOODY PKWY
Second Line	:
City	:	MOODY
State	:	AL
Zip	:	35004-3101
Country	:	US
Telephone Number	:	205-640-2808
Fax Number	:	205-640-2810

Provider Business Practice Location Address
First Line	:	2834 MOODY PKWY
Second Line	:
City	:	MOODY
State	:	AL
Zip	:	35004-3101
Country	:	US
Telephone Number	:	205-640-2808
Fax Number	:	205-640-2810

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	03/02/2010

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