Basic Information
| Provider Information | |||||||||
| NPI: | 1740436252 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEREZ | ||||||||
| FirstName: | LUIS | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 SAINT CLAIR AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT MARYS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458852400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193001129 | ||||||||
| FaxNumber: | 4193949575 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 PRO DR STE D1 | ||||||||
| Address2: | |||||||||
| City: | CELINA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195866489 | ||||||||
| FaxNumber: | 4195868509 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2008 | ||||||||
| LastUpdateDate: | 08/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34.009754 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 9934723 | 01 | OH | GROUP MEDICARE PTAN | OTHER | H319241 | 01 | OH | MEDICARE PTAN | OTHER | 1184652539 | 01 | OH | GROUP NPI | OTHER | 3141817 | 05 | OH | MEDICAID | 01050656 | 01 | OH | GROUP MEDICAID | OTHER | 34-1689161 | 01 | OH | GROUP TAX ID | OTHER |