Healthcare Provider Details

I. General information

NPI: 1922037589
Provider Name (Legal Business Name): WILMER PEREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34503 9TH AVE S STE 230
FEDERAL WAY WA
98003-8726
US

IV. Provider business mailing address

34503 9TH AVE S STE 230
FEDERAL WAY WA
98003-8726
US

V. Phone/Fax

Practice location:
  • Phone: 253-838-3103
  • Fax: 360-744-6270
Mailing address:
  • Phone: 253-838-3103
  • Fax: 360-744-6270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD00048425
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberMD00048425
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: