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General NPI Number Information
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NPI Number | 1003834276
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Entity Type | Individual
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Provider Name | WILLY G PEREIRA M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 09/15/2009
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Provider Practice Location Address
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Address Line | 6155 E HARRY ST
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City | WICHITA
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State | KS
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Zip | 67218-3827
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Country | US
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Telephone | 316-682-1754
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Fax |
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Provider Business Mailing Address
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Address Line | 6155 E HARRY ST
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City | WICHITA
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State | KS
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Zip | 67218-3827
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Country | US
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Telephone | 316-682-1754
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0415565
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License Number State | KS
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