Provider Demographics
NPI:1437189834
Name:PERKINS, FREDERICK H (DO)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:H
Last Name:PERKINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SKYLINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-3363
Mailing Address - Country:US
Mailing Address - Phone:479-968-2345
Mailing Address - Fax:479-890-2497
Practice Address - Street 1:101 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-3363
Practice Address - Country:US
Practice Address - Phone:479-968-2345
Practice Address - Fax:479-890-2497
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3020208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
7888120OtherAETNA
0000214359304OtherUNITED HEALTH CARE
AR770258401OtherBREASTCARE
0200495120OtherRAILROAD MEDICARE
AR143718003Medicaid
19366000000OtherQUALCHOICE
5L881Medicare ID - Type Unspecified
AR770258401OtherBREASTCARE