Healthcare Provider Details

I. General information

NPI: 1659575041
Provider Name (Legal Business Name): GILBERT B PEREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111B ROBERTS RD
GRINDSTONE PA
15442-1105
US

IV. Provider business mailing address

211 EASY ST SUITE 127
UNIONTOWN PA
15401-3129
US

V. Phone/Fax

Practice location:
  • Phone: 724-785-2286
  • Fax: 724-785-3187
Mailing address:
  • Phone: 724-430-8755
  • Fax: 724-434-1659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD441480
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: