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1801162029

NPI Code Detail

MEDICARE: JONATHAN DAVID PEREZ M.D.

MEDICARE: JONATHAN DAVID PEREZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	S5466	TX
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	S5466	TX
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	078451	GA
4	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	MT208166	PA
5	207R00000X	Internal Medicine Physician	4301101436	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1M9724	OTHER	TX	MEDICARE

General Provider Information

NPI Number	:	1801162029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN DAVID PEREZ M.D.

Provider Business Mailing Address
First Line	:	777 HEMLOCK STREET
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31201
Country	:	US
Telephone Number	:	478-633-1000
Fax Number	:	478-633-6161

Provider Business Practice Location Address
First Line	:	800 E DAWSON ST
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-2036
Country	:	US
Telephone Number	:	903-606-5864
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2012
Last Update Date	:	04/06/2026

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Directions to “ JONATHAN DAVID PEREZ M.D.” Practice Location

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