Provider Demographics
NPI:1154383636
Name:MUKUNYADZI, PERKINS (MD)
Entity type:Individual
Prefix:DR
First Name:PERKINS
Middle Name:
Last Name:MUKUNYADZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100559
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-0559
Mailing Address - Country:US
Mailing Address - Phone:843-664-4300
Mailing Address - Fax:843-664-4308
Practice Address - Street 1:1 SAINT VINCENT CIR
Practice Address - Street 2:SUITE 160
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5405
Practice Address - Country:US
Practice Address - Phone:501-663-4116
Practice Address - Fax:501-663-4301
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0863207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00224579Medicare PIN
AR5K968Medicare ID - Type Unspecified
G80459Medicare UPIN
AR5K968Medicare PIN