Provider Demographics
NPI:1265626543
Name:PEREZ, JUNIOR M (IND DUTY CORPSMAN)
Entity type:Individual
Prefix:MR
First Name:JUNIOR
Middle Name:M
Last Name:PEREZ
Suffix:
Gender:M
Credentials:IND DUTY CORPSMAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 GREEN GARDEN CIR
Mailing Address - Street 2:APT-101
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-2240
Mailing Address - Country:US
Mailing Address - Phone:757-450-7321
Mailing Address - Fax:
Practice Address - Street 1:USS ARLEIGH BURKE DDG 51
Practice Address - Street 2:MEDICAL DEPARTMENT
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09565 1269
Practice Address - Country:US
Practice Address - Phone:757-444-4323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman