Provider Demographics
NPI:1336739911
Name:PERKINS, COLTON JACK
Entity Type:Individual
Prefix:
First Name:COLTON
Middle Name:JACK
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 1:66849 LANDSTUHL, GERMANY
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:01980
Mailing Address - Country:US
Mailing Address - Phone:210-996-9358
Mailing Address - Fax:
Practice Address - Street 1:TINKER AFB
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:73145
Practice Address - Country:US
Practice Address - Phone:405-986-3063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians