Provider Demographics
NPI:1083627814
Name:PEREZ, MANUEL JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:JOSE
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 HOSPITAL CENTER BLVD
Mailing Address - Street 2:MEDICAL PAVILION SUITE 302
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2738
Mailing Address - Country:US
Mailing Address - Phone:843-681-8203
Mailing Address - Fax:843-689-6283
Practice Address - Street 1:25 HOSPITAL CENTER BLVD
Practice Address - Street 2:MEDICAL PAVILION SUITE 302
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-2738
Practice Address - Country:US
Practice Address - Phone:843-681-8203
Practice Address - Fax:843-689-6283
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC23230208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC232304Medicaid
SCG581856801Medicare ID - Type Unspecified
SC232304Medicaid
SC5251480001Medicare NSC