Provider Demographics
NPI:1972510477
Name:PERLMAN, JONATHAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:P
Last Name:PERLMAN
Suffix:
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 1:610 COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3615
Mailing Address - Country:US
Mailing Address - Phone:530-666-0333
Mailing Address - Fax:530-666-0352
Practice Address - Street 1:610 COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3615
Practice Address - Country:US
Practice Address - Phone:530-666-0333
Practice Address - Fax:530-666-0352
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G061218174400000X
CAG61218207W00000X, 2082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G061218Medicaid
CAE07511Medicare UPIN
E07511Medicare UPIN
CA00G061218Medicaid