Healthcare Provider Details

I. General information

NPI: 1639598972
Provider Name (Legal Business Name): TOMY YOJAN PEREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 BROADWAY ST
BOULDER CO
80304-3573
US

IV. Provider business mailing address

PO BOX 1589
BOULDER CO
80306-1589
US

V. Phone/Fax

Practice location:
  • Phone: 303-440-3000
  • Fax:
Mailing address:
  • Phone: 413-433-6317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberDR0072496
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD2019-0913
License Number StateNM

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: