Provider Demographics
NPI:1093746471
Name:PERRET, JOHN NELSON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:NELSON
Last Name:PERRET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25165 BICKHAM RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:LA
Mailing Address - Zip Code:70748-4329
Mailing Address - Country:US
Mailing Address - Phone:225-654-4462
Mailing Address - Fax:225-654-3288
Practice Address - Street 1:5825 AIRLINE HWY
Practice Address - Street 2:EMERGENCY MEDICINE RESIDENCY BLDG
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805
Practice Address - Country:US
Practice Address - Phone:225-358-3940
Practice Address - Fax:225-354-2015
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA013939207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAB89746Medicare UPIN