Provider Demographics
NPI:1386647576
Name:PEREZ-MONTES, MARCELO R (MD)
Entity type:Individual
Prefix:
First Name:MARCELO
Middle Name:R
Last Name:PEREZ-MONTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 IRONCREEK PL
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-7772
Mailing Address - Country:US
Mailing Address - Phone:252-422-8499
Mailing Address - Fax:919-267-9486
Practice Address - Street 1:100 IRONCREEK PL
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27539-7772
Practice Address - Country:US
Practice Address - Phone:252-422-8499
Practice Address - Fax:919-267-9486
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-004242083P0500X, 208D00000X
OK204192083P0500X, 208D00000X
MI0717212083P0500X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900539Medicaid
NC2039024Medicare ID - Type UnspecifiedPROVIDER NUMBER
NCG63617Medicare UPIN
NC2346144Medicare ID - Type UnspecifiedGROUP NUMBER