Provider Demographics
NPI:1225142532
Name:PEREZ, VICTOR MANUEL SR (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:MANUEL
Last Name:PEREZ
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6300 W 143RD ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2907
Mailing Address - Country:US
Mailing Address - Phone:913-685-1108
Mailing Address - Fax:913-685-1129
Practice Address - Street 1:6300 W 143RD ST
Practice Address - Street 2:SUITE 210
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2907
Practice Address - Country:US
Practice Address - Phone:913-685-1108
Practice Address - Fax:913-685-1129
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2014-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS04-297582086S0122X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100421060AMedicaid
KS100421060AMedicaid
KS009B815AMedicare ID - Type Unspecified