Provider Demographics
NPI:1033188628
Name:PEREZ, ELLIOT E (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:E
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ESTANCIAS DEL RIO CALLE PORTUGUES 506
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660
Mailing Address - Country:US
Mailing Address - Phone:787-899-4110
Mailing Address - Fax:
Practice Address - Street 1:65 DE INFANTERIA #23B
Practice Address - Street 2:
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00660
Practice Address - Country:US
Practice Address - Phone:787-899-4110
Practice Address - Fax:787-899-4110
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13971173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0021306Medicare ID - Type Unspecified