Provider Demographics
NPI:1275198848
Name:PEREZ, LOUIS (PA-C, MPAS)
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:LOUIS
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:925 NEEDLERUSH RD
Mailing Address - Street 2:
Mailing Address - City:SNEADS FERRY
Mailing Address - State:NC
Mailing Address - Zip Code:28460-5401
Mailing Address - Country:US
Mailing Address - Phone:956-536-9598
Mailing Address - Fax:
Practice Address - Street 1:100 BREWSTER BLVD
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547-2575
Practice Address - Country:US
Practice Address - Phone:910-451-7820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-08
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
No286500000XHospitalsMilitary Hospital
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical