Provider Demographics
NPI:1083757249
Name:PEREZ-RODRIGUEZ, JOSE E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:E
Last Name:PEREZ-RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 566627
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33256-6627
Mailing Address - Country:US
Mailing Address - Phone:305-274-8040
Mailing Address - Fax:305-279-7880
Practice Address - Street 1:7000 SW 97TH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1494
Practice Address - Country:US
Practice Address - Phone:305-274-8040
Practice Address - Fax:305-279-7880
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME312552080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63572Medicare UPIN