Individual
ERNESTO MATOS PEREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4040 LAQUESTA DR, NEOSHO, MO 64850
(417) 283-4953
(417) 283-4954
Mailing address
4040 LAQUESTA DR, NEOSHO, MO 64850
(417) 283-4953
(417) 283-4954
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
2019000641
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/20/2016
Last updated
03/29/2021
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