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General NPI Number Information
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NPI Number | 1013461060
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Entity Type | Individual
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Provider Name | JOSE LUIS PEREZ LARA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/08/2016
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Last Update Date | 04/13/2025
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Provider Practice Location Address
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Address Line | 1602 SKIPWITH RD
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City | RICHMOND
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State | VA
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Zip | 23229-5205
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Country | US
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Telephone | 804-289-4500
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Fax | 757-512-8262
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Provider Business Mailing Address
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Address Line | 105 BENNINGTON CT
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City | YORKTOWN
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State | VA
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Zip | 23693-5575
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Country | US
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Telephone | 312-292-6173
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Fax | 757-512-8262
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101274652
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 0101274652
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 036.165327
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 0101274652
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License Number State | VA
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