Provider Demographics
NPI:1659508372
Name:PEREZ, OMAR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:OMAR
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:OMAR
Other - Middle Name:
Other - Last Name:PEREZ-FIGUEROA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:1270 SUMMIT DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99712
Mailing Address - Country:US
Mailing Address - Phone:787-674-6332
Mailing Address - Fax:
Practice Address - Street 1:1060 GAFFNEY RD, FORT WAINWRIGHT, AK 99703
Practice Address - Street 2:
Practice Address - City:FT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703
Practice Address - Country:US
Practice Address - Phone:907-361-5658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9218623163W00000X
FLRN9218623367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse