Provider Demographics
NPI:1790882140
Name:PEREZ, JOHN CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHARLES
Last Name:PEREZ
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:PO BOX 734
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00821-0734
Mailing Address - Country:US
Mailing Address - Phone:340-719-0001
Mailing Address - Fax:340-719-0009
Practice Address - Street 1:BEESTON HILL MEDICAL CENTER
Practice Address - Street 2:SUITE #7
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-719-0001
Practice Address - Fax:340-719-0009
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
VIVI950207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI0080246Medicare UPIN
VIF48082Medicare PIN