Healthcare Provider Details

I. General information

NPI: 1770637902
Provider Name (Legal Business Name): DOEL R. PEREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 AVE WINSTON CHURCHILL SUITE 406
SAN JUAN PR
00926-6651
US

IV. Provider business mailing address

SAN FRANCISCO MALL P.O. BOX 270317
SAN JUAN PR
00901-1754
US

V. Phone/Fax

Practice location:
  • Phone: 787-753-4198
  • Fax: 787-758-7531
Mailing address:
  • Phone: 787-753-4198
  • Fax: 787-758-7531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number7489
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: