Provider Demographics
NPI:1407084759
Name:GORDILLO PEREZ, ROBERTO (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:GORDILLO PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBERTO
Other - Middle Name:
Other - Last Name:GORDILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:530 NE GLEN OAK AVE
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61637-0001
Mailing Address - Country:US
Mailing Address - Phone:309-624-3313
Mailing Address - Fax:309-655-2565
Practice Address - Street 1:530 NE GLEN OAK AVE
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61637-0001
Practice Address - Country:US
Practice Address - Phone:309-624-3313
Practice Address - Fax:309-655-2565
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1269242080P0210X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics