Provider Demographics
NPI:1023105889
Name:PERKINS, PHILIP G (DO)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:G
Last Name:PERKINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 BRIDGEPORT WAY WEST, STE. 2-G
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4725
Mailing Address - Country:US
Mailing Address - Phone:253-565-9513
Mailing Address - Fax:253-565-5899
Practice Address - Street 1:2607 BRIDGEPORT WAY WEST, STE 2-G
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4725
Practice Address - Country:US
Practice Address - Phone:253-565-9513
Practice Address - Fax:253-565-5899
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP000009572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1100460Medicaid
WA1100460Medicaid