Provider Demographics
NPI:1457458887
Name:PINERO PERAZA, JOSE MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MANUEL
Last Name:PINERO PERAZA
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 1:224 SE 24TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32641-7516
Mailing Address - Country:US
Mailing Address - Phone:352-334-7910
Mailing Address - Fax:352-334-7957
Practice Address - Street 1:224 SE 24TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32641-7516
Practice Address - Country:US
Practice Address - Phone:352-334-7910
Practice Address - Fax:352-334-7957
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12816208D00000X
FLACN547208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012593000Medicaid
PRH82749Medicare UPIN
PR89803Medicare PIN