Provider Demographics
NPI:1629821863
Name:PERKINS, GERALD MILTON (AAS, PWS)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:MILTON
Last Name:PERKINS
Suffix:
Gender:M
Credentials:AAS, PWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4923 NE MLK JR BLVD # 102
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-3353
Mailing Address - Country:US
Mailing Address - Phone:941-990-1888
Mailing Address - Fax:
Practice Address - Street 1:4943 NE MLK JR BLVD STE 103
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-3353
Practice Address - Country:US
Practice Address - Phone:971-980-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist