Provider Demographics
NPI:1417043696
Name:PERKINS, ERNEST B (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:B
Last Name:PERKINS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 STANLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:OK
Mailing Address - Zip Code:74536
Mailing Address - Country:US
Mailing Address - Phone:918-569-4143
Mailing Address - Fax:918-569-4305
Practice Address - Street 1:109 STANLEY ROAD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:OK
Practice Address - Zip Code:74536
Practice Address - Country:US
Practice Address - Phone:918-569-4143
Practice Address - Fax:918-569-4305
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA470363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKR10969Medicare UPIN