Provider Demographics
NPI:1912161571
Name:PERKINS, EDDIE STEELY (DO)
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:STEELY
Last Name:PERKINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 WATTS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769-7208
Mailing Address - Country:US
Mailing Address - Phone:606-539-0188
Mailing Address - Fax:
Practice Address - Street 1:561 WATTS CREEK RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-7208
Practice Address - Country:US
Practice Address - Phone:606-539-0188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY02502207V00000X
KY02502208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64025026Medicaid