Individual
KEVIN DALE PERDUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1900 REDROCK DR, GALLUP, NM 87301-5682
(505) 863-7200
(505) 726-6720
Mailing address
1901 REDROCK DR, GALLUP, NM 87301-5683
(505) 863-7000
(505) 726-6720
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD2006-0520
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10027150
LOVELACE
NM
05
—
124003
—
AZ
05
—
56238835
—
NM
01
—
NM001H96
BCBS
NM
01
—
QMYPR0072225
MOLINA
NM
Enumeration date
07/21/2006
Last updated
07/09/2007
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