Provider Demographics
NPI:1740436252
Name:PEREZ, LUIS L (DO)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:L
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1 PRESTIGE PL STE 550
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6115
Mailing Address - Country:US
Mailing Address - Phone:937-762-1310
Mailing Address - Fax:937-522-8068
Practice Address - Street 1:1250 W NATIONAL RD STE 400
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45315-9506
Practice Address - Country:US
Practice Address - Phone:937-836-6000
Practice Address - Fax:937-832-4805
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2023-04-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34.009754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3141817Medicaid
OHH319241OtherMEDICARE PTAN
OH01050656OtherGROUP MEDICAID
OH9934723OtherGROUP MEDICARE PTAN
OH1184652539OtherGROUP NPI
OH34-1689161OtherGROUP TAX ID