Provider Demographics
NPI:1285048835
Name:PERRIN, BETHANY (DO)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:PERRIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-5236
Mailing Address - Country:US
Mailing Address - Phone:574-533-7600
Mailing Address - Fax:574-533-7666
Practice Address - Street 1:2016 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-5236
Practice Address - Country:US
Practice Address - Phone:574-533-7600
Practice Address - Fax:574-533-7666
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02005143A207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN3000007455Medicaid