Provider Demographics
NPI:1306837414
Name:PEREZ, ISABEL B (MD)
Entity Type:Individual
Prefix:MS
First Name:ISABEL
Middle Name:B
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:ISABEL
Other - Middle Name:B
Other - Last Name:BUENCAMINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12303 DE PAUL DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2512
Mailing Address - Country:US
Mailing Address - Phone:314-344-7049
Mailing Address - Fax:314-344-7073
Practice Address - Street 1:12303 DE PAUL DR
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2512
Practice Address - Country:US
Practice Address - Phone:314-344-7049
Practice Address - Fax:314-344-7073
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR9205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D91162Medicare UPIN
MOD04012694Medicare ID - Type Unspecified