Provider Demographics
NPI:1952415788
Name:PEREZ, OSCAR O JR (DO)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:O
Last Name:PEREZ
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-903-0268
Mailing Address - Fax:859-428-1444
Practice Address - Street 1:405 VIOLET RD
Practice Address - Street 2:
Practice Address - City:CRITTENDEN
Practice Address - State:KY
Practice Address - Zip Code:41030-8956
Practice Address - Country:US
Practice Address - Phone:859-903-0268
Practice Address - Fax:859-428-1444
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02005323A207Q00000X
KY02598207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01721100OtherRR MEDICARE
KY64025947Medicaid
OH0179313Medicaid
G65445Medicare UPIN
KYK041274Medicare PIN
KYP01721100OtherRR MEDICARE