Provider Demographics
NPI:1205029089
Name:PERKINS, JOSEPH L
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:PERKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:WV
Mailing Address - Zip Code:26560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 MAIN ST
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:WV
Practice Address - Zip Code:26560
Practice Address - Country:US
Practice Address - Phone:304-278-5744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1001-6444146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic