Healthcare Provider Details

I. General information

NPI: 1831146810
Provider Name (Legal Business Name): ROBERTO JOSE PEREYO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 HEYWOOD AVE
SPARTANBURG SC
29307
US

IV. Provider business mailing address

475 HEYWOOD AVE
SPARTANBURG SC
29307-1726
US

V. Phone/Fax

Practice location:
  • Phone: 864-699-5020
  • Fax: 864-699-5050
Mailing address:
  • Phone: 864-699-5020
  • Fax: 864-699-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number26056
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: