Provider Demographics
NPI:1033305826
Name:PEREZ, DEO SAMSON MACABIO (PAC)
Entity Type:Individual
Prefix:
First Name:DEO SAMSON
Middle Name:MACABIO
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3124 S 19TH ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2433
Mailing Address - Country:US
Mailing Address - Phone:253-301-5100
Mailing Address - Fax:253-301-5101
Practice Address - Street 1:3124 S 19TH ST
Practice Address - Street 2:SUITE 320
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2433
Practice Address - Country:US
Practice Address - Phone:253-301-5100
Practice Address - Fax:253-301-5101
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2014-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAPA10005222363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical