Provider Demographics
NPI:1285615088
Name:PEREZ, ELIZABETH ZUMWALT (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ZUMWALT
Last Name:PEREZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 BRIGHAM ST
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-6031
Mailing Address - Country:US
Mailing Address - Phone:802-888-8823
Mailing Address - Fax:802-888-8825
Practice Address - Street 1:51 BRIGHAM ST
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-6031
Practice Address - Country:US
Practice Address - Phone:802-888-8823
Practice Address - Fax:802-888-8825
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD29024208800000X
VT042-0010052208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN2326Medicaid
H19613Medicare UPIN
VTVN2326Medicare PIN