Basic Information
| Provider Information | |||||||||
| NPI: | 1508859042 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERKINS | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17609 OLD JEFFERSON HWY STE D | ||||||||
| Address2: | |||||||||
| City: | PRAIRIEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707693980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257655500 | ||||||||
| FaxNumber: | 2256779695 | ||||||||
| Practice Location | |||||||||
| Address1: | 17609 OLD JEFFERSON HWY STE D | ||||||||
| Address2: | |||||||||
| City: | PRAIRIEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707693980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257655500 | ||||||||
| FaxNumber: | 2256779695 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 06/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 021555 | LA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1950424 | 05 | LA | MEDICAID |