Provider Demographics
NPI:1104854660
Name:PERKINSON, BYRON LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:LEONARD
Last Name:PERKINSON
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 1:800 S ASH ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-3224
Mailing Address - Country:US
Mailing Address - Phone:417-667-3355
Mailing Address - Fax:417-667-4234
Practice Address - Street 1:900 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-3210
Practice Address - Country:US
Practice Address - Phone:417-667-6015
Practice Address - Fax:417-448-8970
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT81270207Q00000X
CA72315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A723150Medicaid
GAP00698300OtherRAILROAD MEDICARE
GAP00698300OtherRAILROAD MEDICARE
CA00A723150Medicaid
CA00A723152Medicare PIN