Provider Demographics
NPI:1245244391
Name:PERKINS, THOMAS RANDOLPH JR (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:RANDOLPH
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 1:2834 MOODY PKWY
Mailing Address - Street 2:
Mailing Address - City:MOODY
Mailing Address - State:AL
Mailing Address - Zip Code:35004-3101
Mailing Address - Country:US
Mailing Address - Phone:205-640-2808
Mailing Address - Fax:205-640-2810
Practice Address - Street 1:2834 MOODY PKWY
Practice Address - Street 2:
Practice Address - City:MOODY
Practice Address - State:AL
Practice Address - Zip Code:35004-3101
Practice Address - Country:US
Practice Address - Phone:205-640-2808
Practice Address - Fax:205-640-2810
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00022846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51504084OtherBLUE CROSS & BLUE SHIELD
AL01D0888565OtherCLIA
AL51504084Medicaid
AL51504084Medicaid
AL51504084OtherBLUE CROSS & BLUE SHIELD