Provider Demographics
NPI:1649453259
Name:PERKINS, ROLLIN MORRIS IV (PA-C)
Entity type:Individual
Prefix:MR
First Name:ROLLIN
Middle Name:MORRIS
Last Name:PERKINS
Suffix:IV
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-3612
Mailing Address - Country:US
Mailing Address - Phone:618-988-9777
Mailing Address - Fax:618-988-9097
Practice Address - Street 1:220 S PARK AVE
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3612
Practice Address - Country:US
Practice Address - Phone:618-988-9777
Practice Address - Fax:618-988-9097
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000000Medicare NSC