Provider Demographics
NPI:1528004579
Name:PEREZ, RAFAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:J
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 1:7000 SW 62ND AVE
Mailing Address - Street 2:SUITE 545-A
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4724
Mailing Address - Country:US
Mailing Address - Phone:305-665-2060
Mailing Address - Fax:305-665-4090
Practice Address - Street 1:7000 SW 62ND AVE
Practice Address - Street 2:SUITE 545-A
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4724
Practice Address - Country:US
Practice Address - Phone:305-665-2060
Practice Address - Fax:305-665-4090
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75777174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270645800Medicaid
FLF31906Medicare UPIN
FL270645800Medicaid
FL46841VMedicare PIN