Provider Demographics
NPI:1437102654
Name:PEREZ, ANDRES M (DPM)
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:M
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:ANDRES
Other - Middle Name:M
Other - Last Name:PEREZ-GOMEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:3165 MCCRORY PL
Mailing Address - Street 2:SUITE 174
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3771
Mailing Address - Country:US
Mailing Address - Phone:407-423-1234
Mailing Address - Fax:407-517-1040
Practice Address - Street 1:15805 SHADDOCK DR STE B
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5769
Practice Address - Country:US
Practice Address - Phone:407-423-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3234213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00431261OtherRAIL ROAD MEDICARE
FL340571100Medicaid
FL340571100Medicaid
FLU7715ZMedicare PIN