Provider Demographics
NPI:1831187921
Name:PERKOWSKI, LISA J (MD PC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:J
Last Name:PERKOWSKI
Suffix:
Gender:F
Credentials:MD PC
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3174
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88221-3174
Mailing Address - Country:US
Mailing Address - Phone:575-302-7407
Mailing Address - Fax:
Practice Address - Street 1:2409 W PIERCE ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3513
Practice Address - Country:US
Practice Address - Phone:575-887-1282
Practice Address - Fax:575-885-9923
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM89-276207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM53956Medicaid
NME65047Medicare UPIN