Provider Demographics
NPI:1114147535
Name:PEREZ-GAUTRIN, ROBERTO E (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:E
Last Name:PEREZ-GAUTRIN
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 1:345 CAMP ST
Mailing Address - Street 2:UNIT 104
Mailing Address - City:W YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02673-2476
Mailing Address - Country:US
Mailing Address - Phone:505-920-4185
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-8098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2316772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology