Provider Demographics
NPI:1508378795
Name:PEREZ, JESUS RUBEN (RDMS)
Entity Type:Individual
Prefix:MR
First Name:JESUS
Middle Name:RUBEN
Last Name:PEREZ
Suffix:
Gender:M
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04963-5335
Mailing Address - Country:US
Mailing Address - Phone:207-465-2384
Mailing Address - Fax:
Practice Address - Street 1:22 FOREST AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:ME
Practice Address - Zip Code:04963-5335
Practice Address - Country:US
Practice Address - Phone:207-465-2384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-29
Last Update Date:2017-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME392272085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound