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Individual
JUAN PEREZ
Active
Individual
JUAN PEREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS021073
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01619414
BCBS OF IL-SECONDARY LOCATION
IL
01
—
01635959
BCBS OF IL -PRIMARY LOCATION
IL
05
—
036100812
—
IL
Enumeration date
01/05/2006
Last updated
06/10/2021
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