Provider Demographics
NPI:1225140312
Name:PERRIN, RICHARD GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:GREGORY
Last Name:PERRIN
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 1:4100 LAKE OTIS PKWY
Mailing Address - Street 2:STE 320
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5231
Mailing Address - Country:US
Mailing Address - Phone:907-563-4810
Mailing Address - Fax:907-563-4811
Practice Address - Street 1:4100 LAKE OTIS PKWY
Practice Address - Street 2:STE 320
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5231
Practice Address - Country:US
Practice Address - Phone:907-563-4810
Practice Address - Fax:907-563-4811
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87647207T00000X
AK141981207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A876470OtherBLUE SHIELD OF CA
A87647OtherBLUE CROSS OF CA
A87647OtherBLUE CROSS OF CA
CA00A876470Medicare ID - Type Unspecified