Healthcare Provider Details

I. General information

NPI: 1831573294
Provider Name (Legal Business Name): AUDRIK L PEREZ-RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 E SPRUCE ST
GARDEN CITY KS
67846-5659
US

IV. Provider business mailing address

410 E SPRUCE ST
GARDEN CITY KS
67846-5659
US

V. Phone/Fax

Practice location:
  • Phone: 620-272-2579
  • Fax: 620-272-2685
Mailing address:
  • Phone: 620-272-2579
  • Fax: 620-272-2685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number04-46375
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: