Active NPI
Ernesto Matos Perez, MD
- General Practice Physician
- Neosho, MO
National Provider Identifier
1275994196
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 2019000641
- Practice address
- 4040 Laquesta Dr
Neosho, MO 64850 - Phone
- (417) 283-4953
- Fax
- (417) 283-4954
- NPI assigned
- Mar 20, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| General Practice Physician | 208D00000X | 2019000641 | MO | Primary |
Addresses
Primary practice location
4040 Laquesta Dr
Neosho, MO 64850
Mailing address
4040 Laquesta Dr
Neosho, MO 64850
Phone (417) 283-4953
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 |
|---|---|---|---|
| 2019000641 | MO | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616976000000",
"number": "1275994196",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4040 LAQUESTA DR",
"city": "NEOSHO",
"state": "MO",
"postal_code": "64850",
"telephone_number": "417-283-4953",
"fax_number": "417-283-4954"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4040 LAQUESTA DR",
"city": "NEOSHO",
"state": "MO",
"postal_code": "64850",
"telephone_number": "417-283-4953",
"fax_number": "417-283-4954"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATOS PEREZ",
"first_name": "ERNESTO",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-03-20",
"last_updated": "2021-03-29",
"certification_date": "2021-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "MO",
"license": "2019000641",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Neosho, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.