Provider Demographics
NPI:1518110220
Name:PEREZ MARTINEZ, CLAUDIA ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:ELIZABETH
Last Name:PEREZ MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MALLARD CREEK RD STE 320
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-5136
Mailing Address - Country:US
Mailing Address - Phone:502-690-8782
Mailing Address - Fax:502-459-0923
Practice Address - Street 1:100 MALLARD CREEK RD STE 320
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5136
Practice Address - Country:US
Practice Address - Phone:502-690-8782
Practice Address - Fax:502-459-0923
Is Sole Proprietor?:No
Enumeration Date:2008-10-25
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238848207L00000X
KY43743207L00000X
NH18529207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110084344AMedicaid
KY7100143700OtherKENTUCKY MEDICAID
KYK066390OtherMEDICARE PTAN