Provider Demographics
NPI:1366445512
Name:PEREZ, LEO A (MD)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:A
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LEONCIO
Other - Middle Name:ANSELMO
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8732 SOMERSWORTH PLACE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-1029
Mailing Address - Country:US
Mailing Address - Phone:813-887-5722
Mailing Address - Fax:
Practice Address - Street 1:8732 SOMERSWORTH PLACE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-1029
Practice Address - Country:US
Practice Address - Phone:813-887-5722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46540207Q00000X, 208U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00036015OtherRAILROAD MEDICARE
FL30813YMedicare PIN
FLP00036015Medicare PIN
FL30813Medicare PIN
FLD54136Medicare UPIN