1285161109 NPI number — CESAR AGUSTIN PEREZ MD

Table of content: CESAR AGUSTIN PEREZ MD (NPI 1285161109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285161109 NPI number — CESAR AGUSTIN PEREZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEREZ
Provider First Name:
CESAR
Provider Middle Name:
AGUSTIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285161109
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 29343
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-2045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-232-8290
Provider Business Mailing Address Fax Number:
903-237-1810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2901 N 4TH STREET
Provider Second Line Business Practice Location Address:
LRMC HOSPITALIST
Provider Business Practice Location Address City Name:
LONGVIEW
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75605-7560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-758-1818
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  S6709 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)