Provider Demographics
NPI:1578554010
Name:PERRIEN, JAMES L JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:PERRIEN
Suffix:JR
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 1:6701 AIRPORT BLVD
Mailing Address - Street 2:SUITE B213
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6705
Mailing Address - Country:US
Mailing Address - Phone:251-633-3120
Mailing Address - Fax:251-633-3115
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE B213
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6705
Practice Address - Country:US
Practice Address - Phone:251-633-3120
Practice Address - Fax:251-633-3115
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11818174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51089780OtherBLUE CROSS
ALC74499Medicare UPIN
AL000089780Medicare UPIN