Provider Demographics
NPI:1477559516
Name:PEREZ, RICHARD ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLEN
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 1:5664 BEE RIDGE RD
Mailing Address - Street 2:STE. 202
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1504
Mailing Address - Country:US
Mailing Address - Phone:941-377-6406
Mailing Address - Fax:941-377-6407
Practice Address - Street 1:5664 BEE RIDGE RD
Practice Address - Street 2:STE. 202
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1504
Practice Address - Country:US
Practice Address - Phone:941-377-6406
Practice Address - Fax:941-377-6407
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2020-03-04
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-11
Provider Licenses
StateLicense IDTaxonomies
FLME56640208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062103000Medicaid
FL45150OtherBC BS PROVIDER #