Healthcare Provider Details

I. General information

NPI: 1235161944
Provider Name (Legal Business Name): EDGARDO PEREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 111 KM 22.9 BO. LARES
LARES PR
00669
US

IV. Provider business mailing address

PO BOX 334
LARES PR
00669
US

V. Phone/Fax

Practice location:
  • Phone: 787-473-3541
  • Fax: 787-563-7971
Mailing address:
  • Phone: 787-563-7971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number13663
License Number StatePR

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: