Provider Demographics
NPI:1386731719
Name:PERMAN, CLINT E (PA)
Entity type:Individual
Prefix:
First Name:CLINT
Middle Name:E
Last Name:PERMAN
Suffix:
Gender:M
Credentials:PA
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 556
Mailing Address - Street 2:
Mailing Address - City:BOWDLE
Mailing Address - State:SD
Mailing Address - Zip Code:57428-0556
Mailing Address - Country:US
Mailing Address - Phone:605-285-6832
Mailing Address - Fax:605-285-6600
Practice Address - Street 1:4401 MAIN ST
Practice Address - Street 2:
Practice Address - City:SELBY
Practice Address - State:SD
Practice Address - Zip Code:57472-2010
Practice Address - Country:US
Practice Address - Phone:605-649-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0505363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6823855Medicaid
SD0041144OtherBLUE CROSS CLINICS
SD6823854Medicaid
SD6823856Medicaid
SDS41144Medicare ID - Type UnspecifiedCLINIC MEDICARE
SD6823854Medicaid
SD6823856Medicaid