Provider Demographics
NPI:1285726505
Name:PERRRINE, JOHN DIXON (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DIXON
Last Name:PERRRINE
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 1:205 RIDGEWAY RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1917
Mailing Address - Country:US
Mailing Address - Phone:859-268-0306
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY HEALTH SERVICE
Practice Address - Street 2:B 163 KENTUCKY CLINIC
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0284
Practice Address - Country:US
Practice Address - Phone:859-323-5823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14035207QA0000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Not Answered207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC73669Medicare UPIN