Provider Demographics
NPI:1982686325
Name:PEREZ, JUAN G (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:G
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-0419
Mailing Address - Country:US
Mailing Address - Phone:978-658-5577
Mailing Address - Fax:978-658-5587
Practice Address - Street 1:20 HOLLAND ST
Practice Address - Street 2:SUITE 407
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2700
Practice Address - Country:US
Practice Address - Phone:978-658-5577
Practice Address - Fax:978-658-5587
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA152751207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ18191OtherBCBS
MAG47820Medicare UPIN
MAJ18191OtherBCBS