Basic Information
Provider Information
NPI: 1265641344
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PERKINS
FirstName: SETH
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4881 NW 8TH AVE
Address2: SUITE 2
City: GAINESVILLE
State: FL
PostalCode: 326054582
CountryCode: US
TelephoneNumber: 3523736338
FaxNumber: 3523736338
Practice Location
Address1: 929 N HWY 441
Address2: STE 501
City: LADY LAKE
State: FL
PostalCode: 321593003
CountryCode: US
TelephoneNumber: 3527536886
FaxNumber: 3523736144
Other Information
ProviderEnumerationDate: 05/22/2007
LastUpdateDate: 03/21/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XME107605FLY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


Home