Provider Demographics
NPI:1205044955
Name:PEREZ-MACNEIL, THERESA (DO)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:PEREZ-MACNEIL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 MCMULLEN BOOTH RD
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-6607
Mailing Address - Country:US
Mailing Address - Phone:727-725-6008
Mailing Address - Fax:
Practice Address - Street 1:3231 MCMULLEN BOOTH RD
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-6607
Practice Address - Country:US
Practice Address - Phone:727-725-6008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9949207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine