Provider Demographics
NPI:1972639797
Name:PERKINS, WILL
Entity Type:Individual
Prefix:MR
First Name:WILL
Middle Name:
Last Name:PERKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 DR MARTIN LUTHER KING JR BLVD W
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-3731
Mailing Address - Country:US
Mailing Address - Phone:561-261-9434
Mailing Address - Fax:
Practice Address - Street 1:865 MARTIN LUTHER KING BLVD W
Practice Address - Street 2:
Practice Address - City:BELLE GLADES
Practice Address - State:FL
Practice Address - Zip Code:33430-3731
Practice Address - Country:US
Practice Address - Phone:561-261-9434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP625-880-47-302-0172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver