Provider Demographics
NPI:1437109477
Name:PEREZ MERCED, MARITZA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARITZA
Middle Name:
Last Name:PEREZ MERCED
Suffix:
Gender:F
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:PO BOX 82969
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33682-2969
Mailing Address - Country:US
Mailing Address - Phone:813-866-0930
Mailing Address - Fax:813-866-0929
Practice Address - Street 1:4620 N 22ND ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-6205
Practice Address - Country:US
Practice Address - Phone:813-272-6240
Practice Address - Fax:813-866-0929
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81640207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264162300Medicaid
FLE7699ZMedicare ID - Type UnspecifiedMEDICARE NUMBER
FL264162300Medicaid