Provider Demographics
NPI:1215966296
Name:PERINO, LLOYD EDWIN (MD)
Entity type:Individual
Prefix:
First Name:LLOYD
Middle Name:EDWIN
Last Name:PERINO
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 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:435-251-3800
Mailing Address - Fax:435-251-3801
Practice Address - Street 1:652 S MEDICAL CENTER DR
Practice Address - Street 2:SUITE 330
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7017
Practice Address - Country:US
Practice Address - Phone:435-251-3800
Practice Address - Fax:435-251-3801
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101263598207RG0100X
UT7932327-1205207RG0100X
WAMD00023676207RG0100X
IDM-5073207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1012541Medicaid
ID003203000Medicaid
VA1215966296Medicaid
ID003203000Medicaid
WA1012541Medicaid
ID1118720Medicare ID - Type UnspecifiedMEDICARE OF IDAHO