Provider Demographics
NPI:1275556268
Name:PEREZ, ERNESTO J (MD)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:J
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 1:1911 S BAYSHORE DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-3216
Mailing Address - Country:US
Mailing Address - Phone:305-785-4317
Mailing Address - Fax:
Practice Address - Street 1:2601 SW 37TH AVE STE 702
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2750
Practice Address - Country:US
Practice Address - Phone:305-648-1087
Practice Address - Fax:305-648-1088
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 55358207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 55358OtherMEDICAL LICENSE