Healthcare Provider Details

I. General information

NPI: 1750326179
Provider Name (Legal Business Name): MARYMER PATRICIA PERALES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 W CLINCH AVE
KNOXVILLE TN
37916-2301
US

IV. Provider business mailing address

1741 SOMERSBY LN
KNOXVILLE TN
37922-7243
US

V. Phone/Fax

Practice location:
  • Phone: 865-541-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD39134
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberMD39134
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: