Provider Demographics
NPI:1033195979
Name:PEREIRA, RYAN J (DPM)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:J
Last Name:PEREIRA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 PLANTATION ISLAND DR S
Mailing Address - Street 2:STE 203A
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-3108
Mailing Address - Country:US
Mailing Address - Phone:904-461-0821
Mailing Address - Fax:904-461-0823
Practice Address - Street 1:1301 PLANTATION ISLAND DR S
Practice Address - Street 2:STE 203
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-3108
Practice Address - Country:US
Practice Address - Phone:904-461-0821
Practice Address - Fax:904-461-0823
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3002213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340356400Medicaid
FL65756OtherBCBS
FL65756XMedicare ID - Type Unspecified
FL4834600001Medicare NSC
U92103Medicare UPIN