Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ME 61121 | FL |
N | 111NI0900X | Internist | ME 61121 | FL |
N | 207RC0200X | Critical Care Medicine | ME61121 | FL |
Y | 207RP1001X | Pulmonary Disease | ME 61121 | FL |
N | 207RS0012X | Sleep Medicine | ME61121 | FL |
NPI | 1053325803 |
---|---|
Provider Name | Jose E Perez |
First Address | Statesville, NC 28687-1845 |
Second Address | Statesville, NC 28625-1953 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 11/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F4804 | (02) | FL |