Provider Demographics
NPI:1982655635
Name:SANTIAGO PEREZ, DWIGHT M (MD)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:M
Last Name:SANTIAGO PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29 CALLE WASHINGTON
Mailing Address - Street 2:ASHFORD MEDICAL CENTER SUITE 306
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1510
Mailing Address - Country:US
Mailing Address - Phone:787-722-5513
Mailing Address - Fax:787-723-8664
Practice Address - Street 1:29 CALLE WASHINGTON
Practice Address - Street 2:ASHFORD MEDICAL CENTER SUITE 306
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1510
Practice Address - Country:US
Practice Address - Phone:787-722-5513
Practice Address - Fax:787-723-8664
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR4528207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY612057300OtherOFFICE OF WORKERS COMPENSATION PROGRAM
OH$$$$$$$$$-00OtherCARE WORKS
KY612057300OtherOFFICE OF WORKERS COMPENSATION PROGRAM