Provider Demographics
NPI:1407837032
Name:PEREZ, BERNARD R (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:R
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 1:4506 WISHART PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-2724
Mailing Address - Country:US
Mailing Address - Phone:813-875-6588
Mailing Address - Fax:813-873-3688
Practice Address - Street 1:4506 WISHART PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2724
Practice Address - Country:US
Practice Address - Phone:813-875-6588
Practice Address - Fax:813-873-3688
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41057207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD85588Medicare UPIN
FL30877Medicare ID - Type Unspecified