Provider Demographics
NPI:1639226731
Name:PEREIRA, MERINER M (MD)
Entity Type:Individual
Prefix:DR
First Name:MERINER
Middle Name:M
Last Name:PEREIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4909 N GLEN PARK PLACE RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4689
Mailing Address - Country:US
Mailing Address - Phone:309-674-7546
Mailing Address - Fax:309-691-9286
Practice Address - Street 1:2300 PARK AVE
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-5444
Practice Address - Country:US
Practice Address - Phone:563-263-2113
Practice Address - Fax:563-263-2619
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD34725207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology