Provider Demographics
NPI:1083670160
Name:PEREZ-MILLAN, ROBERTO (MD, PA)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:PEREZ-MILLAN
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 N HABANA AVE
Mailing Address - Street 2:SUITE 28
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7166
Mailing Address - Country:US
Mailing Address - Phone:813-873-2800
Mailing Address - Fax:813-873-2811
Practice Address - Street 1:4600 N HABANA AVE
Practice Address - Street 2:SUITE 28
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7166
Practice Address - Country:US
Practice Address - Phone:813-873-2800
Practice Address - Fax:813-961-8593
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0088669208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1455194OtherCIGNA
FL16150OtherBLUE CROSS
FL2874886OtherUNITED
FL7935347OtherAETNA
FL2726645-00Medicaid
FL1455194OtherCIGNA
FLU4785YMedicare PIN