Provider Demographics
NPI:1699866061
Name:PEREZ, ROBERT G (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:PEREZ
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 1:1800 SULLIVAN AVE
Mailing Address - Street 2:SUITE 507
Mailing Address - City:DALLY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015
Mailing Address - Country:US
Mailing Address - Phone:650-994-9936
Mailing Address - Fax:650-994-2016
Practice Address - Street 1:1800 SULLIVAN AVE
Practice Address - Street 2:SUITE 507
Practice Address - City:DALLY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015
Practice Address - Country:US
Practice Address - Phone:650-994-9936
Practice Address - Fax:650-994-2016
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58842208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G588420Medicare ID - Type Unspecified
C49582Medicare UPIN