Provider Demographics
NPI:1760480172
Name:PEREA, PEDRO ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:ROBERTO
Last Name:PEREA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3716
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3716
Mailing Address - Country:US
Mailing Address - Phone:787-832-9333
Mailing Address - Fax:787-832-9333
Practice Address - Street 1:CALLE POST, 19 N. ST
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-832-9333
Practice Address - Fax:787-832-9333
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR3696207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D08647Medicare UPIN