Provider Demographics
NPI:1336709989
Name:PERDUE, JUSTIN G (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:G
Last Name:PERDUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4076 NEELY RD, BASSETT ARMY COMMUNITY HOSPITAL
Mailing Address - Street 2:USA MEDDAC-AK ATTN: MCUC-MMD-QM (CREDENTIALS)
Mailing Address - City:FORT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-7440
Mailing Address - Country:US
Mailing Address - Phone:423-483-9293
Mailing Address - Fax:
Practice Address - Street 1:4076 NEELY RD, BASSETT ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:USA MEDDAC-AK ATTN: MCUC-MMD-QM (CREDENTIALS)
Practice Address - City:FORT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703-7440
Practice Address - Country:US
Practice Address - Phone:423-483-9293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN61988207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN61988OtherTN STATE LICENSE