Provider Demographics
NPI:1124650411
Name:PEREZ, ELMER (MED)
Entity type:Individual
Prefix:
First Name:ELMER
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:FL
Mailing Address - Zip Code:32784
Mailing Address - Country:US
Mailing Address - Phone:386-453-4469
Mailing Address - Fax:
Practice Address - Street 1:366 LAKE ST
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:FL
Practice Address - Zip Code:32784
Practice Address - Country:US
Practice Address - Phone:386-453-4469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty