Provider Demographics
NPI:1821026212
Name:PERKINS, THOMAS O (PA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:O
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 1:5718 SPOHN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4116
Mailing Address - Country:US
Mailing Address - Phone:361-980-0808
Mailing Address - Fax:361-653-7041
Practice Address - Street 1:5718 SPOHN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4116
Practice Address - Country:US
Practice Address - Phone:361-980-0808
Practice Address - Fax:361-653-7041
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02412363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F2543Medicare ID - Type Unspecified