Provider Demographics
NPI:1245430164
Name:EDWARD R PERON MD PA
Entity Type:Organization
Organization Name:EDWARD R PERON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:PERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-595-3414
Mailing Address - Street 1:10260 SW 56TH ST
Mailing Address - Street 2:SUITE# 102
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7015
Mailing Address - Country:US
Mailing Address - Phone:305-595-3414
Mailing Address - Fax:305-279-8848
Practice Address - Street 1:10260 SW 56TH ST
Practice Address - Street 2:SUITE# 102
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7015
Practice Address - Country:US
Practice Address - Phone:305-595-3414
Practice Address - Fax:305-279-8848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AI348Medicare PIN