Provider Demographics
NPI:1881660645
Name:PEREZ, MARLOW (MD)
Entity Type:Individual
Prefix:DR
First Name:MARLOW
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 S PERRY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1919
Mailing Address - Country:US
Mailing Address - Phone:303-218-7774
Mailing Address - Fax:303-805-7732
Practice Address - Street 1:831 S PERRY
Practice Address - Street 2:SUITE 200
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1919
Practice Address - Country:US
Practice Address - Phone:303-218-7774
Practice Address - Fax:303-805-7732
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49594207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP01540302OtherMEDICARE RR
CO37958071Medicaid
CO37958071Medicaid