Healthcare Provider Details

I. General information

NPI: 1124095591
Provider Name (Legal Business Name): EDWARD ALEXANDER PEREZ-CONDE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E H ST
IRON MOUNTAIN MI
49801-4760
US

IV. Provider business mailing address

PO BOX 549
IRON MOUNTAIN MI
49801-0549
US

V. Phone/Fax

Practice location:
  • Phone: 906-774-3300
  • Fax:
Mailing address:
  • Phone: 906-774-1313
  • Fax: 906-776-5639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number4301071310
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301071310
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: