Healthcare Provider Details

I. General information

NPI: 1982655635
Provider Name (Legal Business Name): DWIGHT M SANTIAGO PEREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 CALLE WASHINGTON ASHFORD MEDICAL CENTER SUITE 306
SAN JUAN PR
00907-1510
US

IV. Provider business mailing address

29 CALLE WASHINGTON ASHFORD MEDICAL CENTER SUITE 306
SAN JUAN PR
00907-1510
US

V. Phone/Fax

Practice location:
  • Phone: 787-722-5513
  • Fax: 787-723-8664
Mailing address:
  • Phone: 787-722-5513
  • Fax: 787-723-8664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number4528
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: