Provider Demographics
NPI:1811412158
Name:PERDUE, CLAIBORNE TUCKER III (NP-C)
Entity Type:Individual
Prefix:MR
First Name:CLAIBORNE
Middle Name:TUCKER
Last Name:PERDUE
Suffix:III
Gender:M
Credentials:NP-C
Other - Prefix:
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Mailing Address - Street 1:8580 MAGELLAN PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1149
Mailing Address - Country:US
Mailing Address - Phone:804-796-2373
Mailing Address - Fax:804-748-9160
Practice Address - Street 1:12901 BRIGGS RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831
Practice Address - Country:US
Practice Address - Phone:804-796-2373
Practice Address - Fax:804-748-9160
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2020-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0024175245363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily