Provider Demographics
NPI:1669553681
Name:PERKINS, ROLLIN MORRIS III (MD)
Entity type:Individual
Prefix:DR
First Name:ROLLIN
Middle Name:MORRIS
Last Name:PERKINS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:374 E. GRAND AVE.
Mailing Address - Street 2:0154E
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-6740
Mailing Address - Country:US
Mailing Address - Phone:618-453-4483
Mailing Address - Fax:618-453-4479
Practice Address - Street 1:374 E. GRAND AVE.
Practice Address - Street 2:0154E
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-6740
Practice Address - Country:US
Practice Address - Phone:618-453-4483
Practice Address - Fax:618-453-4479
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF69554Medicare UPIN