Provider Demographics
NPI:1205895158
Name:PEROZEK, TIMOTHY A (M D)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:PEROZEK
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 N TOWN CENTER DR
Mailing Address - Street 2:SUITE 212
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0514
Mailing Address - Country:US
Mailing Address - Phone:702-982-1360
Mailing Address - Fax:702-202-3489
Practice Address - Street 1:653 N TOWN CENTER DR
Practice Address - Street 2:SUITE 212
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0514
Practice Address - Country:US
Practice Address - Phone:702-982-1360
Practice Address - Fax:702-202-3489
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11220174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVH54752Medicare UPIN