Provider Demographics
NPI:1487691424
Name:PERKINS, RANDALL C (DO)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:C
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 1:1322 REGENCY CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-9515
Mailing Address - Country:US
Mailing Address - Phone:817-571-8912
Mailing Address - Fax:
Practice Address - Street 1:3801 WILLIAM D TATE AVE STE 840
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8755
Practice Address - Country:US
Practice Address - Phone:817-310-3772
Practice Address - Fax:817-310-3950
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3404207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111838207Medicaid
TX111838205Medicaid
TX111838204Medicaid
TXA67493Medicare UPIN
TX8L8923Medicare PIN
TX8B4580Medicare PIN
TX111838204Medicaid
TXTXB123128Medicare PIN