Provider Demographics
NPI:1033218821
Name:PERDOMO, ARLES
Entity Type:Individual
Prefix:
First Name:ARLES
Middle Name:
Last Name:PERDOMO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3677 CENTRAL AVE STE I
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8226
Mailing Address - Country:US
Mailing Address - Phone:239-944-0918
Mailing Address - Fax:239-237-5165
Practice Address - Street 1:3677 CENTRAL AVE STE I
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8226
Practice Address - Country:US
Practice Address - Phone:239-944-0918
Practice Address - Fax:239-237-5165
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87444207P00000X, 208D00000X
FLME874444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262307200Medicaid
FLU1633ZMedicare PIN