Provider Demographics
NPI:1518906312
Name:PERL, JOHN II (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:PERL
Suffix:II
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 1:2686 E WINDSONG DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-5010
Mailing Address - Country:US
Mailing Address - Phone:612-863-1044
Mailing Address - Fax:
Practice Address - Street 1:190 E BANNOCK
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712
Practice Address - Country:US
Practice Address - Phone:208-381-2094
Practice Address - Fax:208-381-1791
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN450892085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN141889OtherUCARE
MN300131501OtherRAILROAD MEDICARE MN
MN62G95PEOtherBLUE CROSS
IA1518906312Medicaid
MN1031170OtherPREFERRED ONE
WI31920500Medicaid
MN1658464OtherAMERICA'S PPO
MNHP35300OtherHEALTHPARTNERS
MN083760100Medicaid
MN302G3PEOtherBLUE CROSS
MN1031170OtherPREFERRED ONE
MNE39017Medicare UPIN
MN300003003Medicare PIN
MN300131501OtherRAILROAD MEDICARE MN
WI31920500Medicaid
IA1518906312Medicaid