Provider Demographics
NPI:1356351407
Name:PEREZ GARCIA, JOSE M (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:M
Last Name:PEREZ GARCIA
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:P.O. BOX 140461
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614
Mailing Address - Country:US
Mailing Address - Phone:787-970-0707
Mailing Address - Fax:
Practice Address - Street 1:10 CALLE GEORGETTI
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-2714
Practice Address - Country:US
Practice Address - Phone:787-970-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11693174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR02498OtherAMERICAN HEALTH
PR060156OtherCRUZ AZUL
PR3033-5-5025OtherASOCIACION MAESTROS
PR212604OtherPREFERRED HEALTH
PR6170027OtherHUMANA
PR8736OtherINTERNATIONAL MEDICAL
PR211693OtherCIGNA
PR100079OtherMMM
PR8-4605Medicare ID - Type UnspecifiedMEDICARE
PRG-40939Medicare UPIN