Provider Demographics
NPI:1922325604
Name:PERDUE, ANNA MARIE (MED)
Entity Type:Individual
Prefix:
First Name:ANNA MARIE
Middle Name:
Last Name:PERDUE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 534
Mailing Address - Street 2:
Mailing Address - City:WELLSTON
Mailing Address - State:OK
Mailing Address - Zip Code:74881-0534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1414 N KENNEDY AVE
Practice Address - Street 2:STE 1111 DOCTOR'S BLDG
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-4700
Practice Address - Country:US
Practice Address - Phone:405-878-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool