Healthcare Provider Details

I. General information

NPI: 1093729006
Provider Name (Legal Business Name): TIMOTHY W. PEREZ M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 DR MARTIN LUTHER KING NE STE 301
ALBUQUERQUE NM
87102-2534
US

IV. Provider business mailing address

715 DR MARTIN LUTHER KING NE STE 301
ALBUQUERQUE NM
87102-2534
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-7090
  • Fax: 505-727-7099
Mailing address:
  • Phone: 505-727-7090
  • Fax: 505-727-7099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number93-126
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number93-126
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: