Provider Demographics
NPI:1821653247
Name:PEREZ MARTELL, JOSE (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:PEREZ MARTELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JP
Other - Middle Name:
Other - Last Name:MARTELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1555 NE RICE RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5849
Mailing Address - Country:US
Mailing Address - Phone:816-347-3069
Mailing Address - Fax:816-347-3200
Practice Address - Street 1:1000 E 24TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2776
Practice Address - Country:US
Practice Address - Phone:816-966-0900
Practice Address - Fax:816-416-7098
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240315052084A0401X
CT734182084P0800X, 2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry