Provider Demographics
NPI:1508859042
Name:PERKINS, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
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 1:17609 OLD JEFFERSON HWY STE D
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3980
Mailing Address - Country:US
Mailing Address - Phone:225-765-5500
Mailing Address - Fax:225-677-9695
Practice Address - Street 1:17609 OLD JEFFERSON HWY STE D
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3980
Practice Address - Country:US
Practice Address - Phone:225-765-5500
Practice Address - Fax:225-677-9695
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021555207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1950424Medicaid
F36030Medicare UPIN
LA5R165Medicare PIN