Provider Demographics
NPI:1659359180
Name:PEREZ, JUAN (DO)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 BERNVILLE RD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-9453
Mailing Address - Country:US
Mailing Address - Phone:610-378-2000
Mailing Address - Fax:610-378-2799
Practice Address - Street 1:145 N 6TH ST FL 1
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3096
Practice Address - Country:US
Practice Address - Phone:610-208-4558
Practice Address - Fax:610-378-2441
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS021073207Q00000X
IL036100812207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635959OtherBCBS OF IL -PRIMARY LOCATION
IL036100812Medicaid
IL01619414OtherBCBS OF IL-SECONDARY LOCATION
ILR03562 EP/DPMedicare PIN
IL01619414OtherBCBS OF IL-SECONDARY LOCATION
IL036100812Medicaid