Provider Demographics
NPI:1710769492
Name:PERKINS, DEL SULLIVAN IV
Entity Type:Individual
Prefix:
First Name:DEL
Middle Name:SULLIVAN
Last Name:PERKINS
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:FORT GIBSON
Mailing Address - State:OK
Mailing Address - Zip Code:74434-8355
Mailing Address - Country:US
Mailing Address - Phone:405-312-4226
Mailing Address - Fax:
Practice Address - Street 1:19500 E ROSS ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-0515
Practice Address - Country:US
Practice Address - Phone:918-525-6191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program