Provider Demographics
NPI:1346324506
Name:PERDUE, DAVID GARETT (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GARETT
Last Name:PERDUE
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:PO BOX 14909
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-0909
Mailing Address - Country:US
Mailing Address - Phone:612-871-1145
Mailing Address - Fax:
Practice Address - Street 1:2550 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 423 SOUTH
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1052
Practice Address - Country:US
Practice Address - Phone:612-871-1145
Practice Address - Fax:612-870-5491
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43435207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0596858Medicaid
MNHP56030OtherHEALTH PARTNERS
MN812915100Medicaid
MN135330OtherUCARE
MN29-00430OtherMEDICA CHOICE
WI34706700Medicaid
MNB664OtherCHAMPUS
MN1612851OtherARAZ
MT0148053Medicaid
MN29-00011OtherMEDICA PRIMARY
P00301059Medicare ID - Type UnspecifiedRAILROAD
MN1612851OtherARAZ
MN135330OtherUCARE