Provider Demographics
NPI:1518383140
Name:PERKINS, TIFFANY (MD)
Entity Type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:
Last Name:PERKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2624 EDITH AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-3092
Mailing Address - Country:US
Mailing Address - Phone:530-241-3316
Mailing Address - Fax:530-241-6319
Practice Address - Street 1:2624 EDITH AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3092
Practice Address - Country:US
Practice Address - Phone:530-241-3316
Practice Address - Fax:530-241-6319
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA163085208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program