Provider Demographics
NPI:1245432970
Name:PEREZ, OLIVER ANGEL (MD)
Entity Type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:ANGEL
Last Name:PEREZ
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 1:6022 SAN JOSE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2358
Mailing Address - Country:US
Mailing Address - Phone:904-387-4991
Mailing Address - Fax:904-384-3613
Practice Address - Street 1:1514 NIRA ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207
Practice Address - Country:US
Practice Address - Phone:904-387-4991
Practice Address - Fax:904-384-3613
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113431207ND0101X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGN120YMedicare PIN
FLGN120ZMedicare PIN