Provider Demographics
NPI:1922037589
Name:PEREZ, WILMER (MD)
Entity Type:Individual
Prefix:
First Name:WILMER
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 1:34503 9TH AVE S STE 230
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8726
Mailing Address - Country:US
Mailing Address - Phone:253-838-3103
Mailing Address - Fax:360-744-6270
Practice Address - Street 1:34503 9TH AVE S STE 230
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8726
Practice Address - Country:US
Practice Address - Phone:253-838-3103
Practice Address - Fax:360-744-6270
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00048425207RS0012X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1922037589Medicaid
WA2070515Medicaid
F02784Medicare UPIN