Basic Information
| Provider Information | |||||||||
| NPI: | 1952415788 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEREZ | ||||||||
| FirstName: | OSCAR | ||||||||
| MiddleName: | O | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 635283 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452635283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8599030268 | ||||||||
| FaxNumber: | 8594281444 | ||||||||
| Practice Location | |||||||||
| Address1: | 405 VIOLET RD | ||||||||
| Address2: | |||||||||
| City: | CRITTENDEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410308956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8599030268 | ||||||||
| FaxNumber: | 8594281444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 11/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 02005323A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 02598 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P01721100 | 01 | KY | RR MEDICARE | OTHER | 64025947 | 05 | KY | MEDICAID | 0179313 | 05 | OH | MEDICAID |