Provider Demographics
NPI:1306000955
Name:JOSE PEREZ-TIRSE MD PA
Entity Type:Organization
Organization Name:JOSE PEREZ-TIRSE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ-TIRSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-226-8484
Mailing Address - Street 1:PO BOX 831706
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33283-1706
Mailing Address - Country:US
Mailing Address - Phone:305-226-8484
Mailing Address - Fax:305-226-8826
Practice Address - Street 1:11760 BIRD RD
Practice Address - Street 2:SUITE 502
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3582
Practice Address - Country:US
Practice Address - Phone:305-226-8484
Practice Address - Fax:305-226-8826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL814Medicare PIN