Provider Demographics
NPI:1871503763
Name:JORGE PEREZ, MD LTD
Entity Type:Organization
Organization Name:JORGE PEREZ, MD LTD
Other - Org Name:SIERRA NEVADA CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-883-3336
Mailing Address - Street 1:1801 W OLYMPIC BLVD
Mailing Address - Street 2:FILE 1359
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91199-1359
Mailing Address - Country:US
Mailing Address - Phone:775-883-3336
Mailing Address - Fax:775-883-0877
Practice Address - Street 1:1460 S CURRY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-5100
Practice Address - Country:US
Practice Address - Phone:775-883-3336
Practice Address - Fax:775-883-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10108174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1871503763OtherNPI#
NV2013150Medicaid
NVG80853OtherMEDICARE RAILROAD
NVV36326Medicare ID - Type UnspecifiedMEDICARE GROUP NUBER