Healthcare Provider Details

I. General information

NPI: 1750732863
Provider Name (Legal Business Name): RAFAEL DE JESUS PEREZ RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RAFAEL PEREZ RODRIGUEZ MD

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BELLINGER ST
EAU CLAIRE WI
54703-5222
US

IV. Provider business mailing address

200 1ST ST SW
ROCHESTER MN
55905-0001
US

V. Phone/Fax

Practice location:
  • Phone: 715-838-5222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number008452
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number76752
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number76752
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: