Provider Demographics
NPI:1952385866
Name:PEREZ, HECTOR FRANCISCO (MD)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:FRANCISCO
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5717 S ANTHONY BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46806-3386
Mailing Address - Country:US
Mailing Address - Phone:260-441-3262
Mailing Address - Fax:260-447-8657
Practice Address - Street 1:5717 S ANTHONY BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46806-3386
Practice Address - Country:US
Practice Address - Phone:260-441-3262
Practice Address - Fax:260-447-8657
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01044945207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100365200BMedicaid
F65526Medicare UPIN
IN100365200BMedicaid