Provider Demographics
NPI:1629188586
Name:PEREZ, GASTON O (MD FAAFP)
Entity Type:Individual
Prefix:DR
First Name:GASTON
Middle Name:O
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 OAK FOREST RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4988
Mailing Address - Country:US
Mailing Address - Phone:843-815-6468
Mailing Address - Fax:843-815-6492
Practice Address - Street 1:14 OAK FOREST RD
Practice Address - Street 2:SUITE D
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4988
Practice Address - Country:US
Practice Address - Phone:843-815-6468
Practice Address - Fax:843-815-6492
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17810207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC17814Medicaid
F90897Medicare UPIN