Individual
DR. ENRIQUE PERALTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3990 N ILLINOIS ST, SWANSEA, IL 62226-1919
(618) 277-1130
(618) 277-4917
Mailing address
3990 N ILLINOIS ST, SWANSEA, IL 62226-1919
(618) 277-1130
(618) 277-4917
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036-112111
IL
207W00000X
Ophthalmology Physician
2004012770
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036112111
—
IL
05
—
209310200
—
MO
Enumeration date
10/03/2005
Last updated
04/16/2026
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