Provider Demographics
NPI:1629141296
Name:PERKINS, CAMERON LUTHER (PA)
Entity Type:Individual
Prefix:MR
First Name:CAMERON
Middle Name:LUTHER
Last Name:PERKINS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 HUNTSWORTH PL
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-9744
Mailing Address - Country:US
Mailing Address - Phone:919-697-0487
Mailing Address - Fax:919-550-7059
Practice Address - Street 1:11491 US HIGHWAY 70 W
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2207
Practice Address - Country:US
Practice Address - Phone:919-550-2484
Practice Address - Fax:919-550-7059
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103236208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2757324Medicare PIN
NC2757324GMedicare PIN
NCP78494Medicare UPIN
NC2757324HMedicare PIN