Provider Demographics
NPI:1336242239
Name:PERKINS, ISSAC (MD)
Entity Type:Individual
Prefix:DR
First Name:ISSAC
Middle Name:
Last Name:PERKINS
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 1:2550 FLOWOOD DR STE 402
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9307
Mailing Address - Country:US
Mailing Address - Phone:601-376-2832
Mailing Address - Fax:601-936-1260
Practice Address - Street 1:1850 CHADWICK DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3404
Practice Address - Country:US
Practice Address - Phone:601-376-2832
Practice Address - Fax:601-936-1260
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11304207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03559373Medicaid
MSP01237616OtherRAILROAD MEDICARE
MSP00466876Medicare PIN
MS03559373Medicaid
MS110002037Medicare PIN
MSP01237616OtherRAILROAD MEDICARE