Provider Demographics
NPI:1366447682
Name:PERKINS, RYAN S (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:S
Last Name:PERKINS
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 1:10881 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-6612
Mailing Address - Country:US
Mailing Address - Phone:904-880-5522
Mailing Address - Fax:904-880-5533
Practice Address - Street 1:10881 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-6612
Practice Address - Country:US
Practice Address - Phone:904-880-5522
Practice Address - Fax:904-880-5533
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME685862085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08691OtherHEALTHEASE
FL28750OtherWELLCARE
FL378240900Medicaid
FL7299313OtherG H I
GA00741474AMedicaid
FL213239OtherAVMED
FL3602304OtherUNITED HEALTHCARE
FL726514800OtherCIGNA
FL920001650OtherRAILROAD MEDICARE
FL213239OtherAVMED
FL27205Medicare ID - Type Unspecified