Basic Information
| Provider Information | |||||||||
| NPI: | 1134213259 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEREZ | ||||||||
| FirstName: | JESUS | ||||||||
| MiddleName: | JAIME | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 182 16TH ST. | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 808071649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193469481 | ||||||||
| FaxNumber: | 7193469485 | ||||||||
| Practice Location | |||||||||
| Address1: | 182 16TH ST. | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 808071649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193469481 | ||||||||
| FaxNumber: | 7193469485 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 03/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 36362 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01363621 | 05 | CO | MEDICAID |