Provider Demographics
NPI:1902339047
Name:PERKINS, HOLLY BACON (MD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:BACON
Last Name:PERKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HOLLY
Other - Middle Name:ELIZABETH
Other - Last Name:BACON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:601 MCCAIN BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92135
Mailing Address - Country:US
Mailing Address - Phone:619-545-6210
Mailing Address - Fax:
Practice Address - Street 1:601 MCCAIN BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92135
Practice Address - Country:US
Practice Address - Phone:619-545-6210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020027000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine