Provider Demographics
NPI:1346235819
Name:PEREZ, NORVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:NORVIN
Middle Name:
Last Name:PEREZ
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 1:8505 OLD DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8042
Mailing Address - Country:US
Mailing Address - Phone:907-790-4111
Mailing Address - Fax:907-790-3111
Practice Address - Street 1:8505 OLD DAIRY RD
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8042
Practice Address - Country:US
Practice Address - Phone:907-790-4111
Practice Address - Fax:907-790-3111
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07510200207P00000X, 2083X0100X, 208D00000X
AK4037207P00000X
AK5909332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD85051Medicaid
NJ8991405Medicaid
NJG88878Medicare UPIN
NJ8991405Medicaid