Basic Information
Provider Information
NPI: 1952415788
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PEREZ
FirstName: OSCAR
MiddleName: O
NamePrefix:  
NameSuffix: JR.
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 635283
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452635283
CountryCode: US
TelephoneNumber: 8124963290
FaxNumber: 8125370400
Practice Location
Address1: 405 VIOLET RD
Address2:  
City: CRITTENDEN
State: KY
PostalCode: 410308956
CountryCode: US
TelephoneNumber: 8594281610
FaxNumber: 8594283923
Other Information
ProviderEnumerationDate: 08/18/2006
LastUpdateDate: 10/08/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X02598KYY Allopathic & Osteopathic PhysiciansFamily Medicine 
207Q00000X02005323AINN Allopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
P0172110001KYRR MEDICAREOTHER
017931305OH MEDICAID
6402594705KY MEDICAID


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