Provider Demographics
NPI:1679552681
Name:PERKINS, TERRY R (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:R
Last Name:PERKINS
Suffix:
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 1:8071 PARK PLACE DR APT 14D
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-3041
Mailing Address - Country:US
Mailing Address - Phone:812-620-7546
Mailing Address - Fax:
Practice Address - Street 1:1808 SHERMAN DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-1000
Practice Address - Country:US
Practice Address - Phone:812-385-3401
Practice Address - Fax:812-385-9249
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN70539207P00000X, 207Q00000X
IL036.144786207P00000X
KY29335207P00000X
IN01035690A207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64047079Medicaid
IN200015080Medicaid
KY64047079Medicaid