Provider Demographics
NPI:1851408801
Name:PERKINS, REX BEACH JR (MD)
Entity Type:Individual
Prefix:
First Name:REX
Middle Name:BEACH
Last Name:PERKINS
Suffix:JR
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 1:845 COUNTY ROAD 57
Mailing Address - Street 2:
Mailing Address - City:GORDO
Mailing Address - State:AL
Mailing Address - Zip Code:35466-3886
Mailing Address - Country:US
Mailing Address - Phone:205-364-7589
Mailing Address - Fax:
Practice Address - Street 1:845 COUNTY ROAD 57
Practice Address - Street 2:
Practice Address - City:GORDO
Practice Address - State:AL
Practice Address - Zip Code:35466-3886
Practice Address - Country:US
Practice Address - Phone:205-364-7589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7256207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC70315Medicare UPIN