Provider Demographics
NPI:1114321882
Name:PEREZ, BROOKE A (PA-C)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:A
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04903-0727
Mailing Address - Country:US
Mailing Address - Phone:207-549-7581
Mailing Address - Fax:207-549-3439
Practice Address - Street 1:47 MAIN ST
Practice Address - Street 2:
Practice Address - City:COOPERS MILLS
Practice Address - State:ME
Practice Address - Zip Code:04341-4047
Practice Address - Country:US
Practice Address - Phone:207-549-7581
Practice Address - Fax:207-549-3439
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1489363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical