Basic Information
| Provider Information | |||||||||
| NPI: | 1225092414 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEREA | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1707 COLE BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | GOLDEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804013220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037168013 | ||||||||
| FaxNumber: | 3037635495 | ||||||||
| Practice Location | |||||||||
| Address1: | 9695 S YOSEMITE ST | ||||||||
| Address2: | STE 324 | ||||||||
| City: | LONE TREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801242888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037069054 | ||||||||
| FaxNumber: | 3033029799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 10/04/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 37293 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.