Provider Demographics
NPI:1528208691
Name:PEREZ, JOSE VICTOR (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:VICTOR
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:680 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6738
Mailing Address - Country:US
Mailing Address - Phone:954-538-6868
Mailing Address - Fax:954-538-6868
Practice Address - Street 1:680 N UNIVERSITY DRIVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6868
Practice Address - Country:US
Practice Address - Phone:954-538-6868
Practice Address - Fax:954-538-6868
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDK774ZMedicare PIN