Provider Demographics
NPI:1912904954
Name:PEREZ, DONALD M (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:M
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:141 W 22ND ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-4304
Mailing Address - Country:US
Mailing Address - Phone:765-649-7146
Mailing Address - Fax:765-646-6042
Practice Address - Street 1:141 W 22ND ST
Practice Address - Street 2:SUITE 112
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4304
Practice Address - Country:US
Practice Address - Phone:765-649-7146
Practice Address - Fax:765-646-6042
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-06
Last Update Date:2014-04-15
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
IN01025158207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4722370001Medicare NSC
INC24257Medicare UPIN