Healthcare Provider Details

I. General information

NPI: 1114543345
Provider Name (Legal Business Name): MEGAN PEREZ VIQUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN PEREZ M.D.

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 N MILDRED RD
CORTEZ CO
81321-2231
US

IV. Provider business mailing address

1311 N MILDRED RD
CORTEZ CO
81321-2231
US

V. Phone/Fax

Practice location:
  • Phone: 970-565-8556
  • Fax: 970-564-1134
Mailing address:
  • Phone: 970-565-6666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0070391
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: