Active NPI
Godofredo Bautista Perez, M.D.
- Family Medicine Physician
- Connellsville, PA
National Provider Identifier
1083705289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD032299-L
- Practice address
- 134 S. Pittsburgh St
Connellsville, PA 15425 - Phone
- (724) 628-0310
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD032299-L | PA | Primary |
Addresses
Primary practice location
134 S. Pittsburgh St
Connellsville, PA 15425
Mailing address
134 S. Pittsburgh St
Connellsville, PA 15425
Phone (724) 628-0310
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD032299-L | PA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083705289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "134 S. PITTSBURGH ST",
"city": "CONNELLSVILLE",
"state": "PA",
"postal_code": "15425",
"telephone_number": "724-628-0310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "134 S. PITTSBURGH ST",
"city": "CONNELLSVILLE",
"state": "PA",
"postal_code": "15425",
"telephone_number": "724-628-0310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEREZ",
"first_name": "GODOFREDO",
"middle_name": "BAUTISTA",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "MD032299-L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Connellsville, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.