Healthcare Provider Details

I. General information

NPI: 1245934256
Provider Name (Legal Business Name): ERIK ROBERT PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 HOSPITAL DR
WINCHESTER KY
40391-9591
US

IV. Provider business mailing address

13122 SW 40TH ST
DAVIE FL
33330-4742
US

V. Phone/Fax

Practice location:
  • Phone: 859-745-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number06420
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: