Provider Demographics
NPI:1558367243
Name:CARRAZANA PEREZ, PEDRO D (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:D
Last Name:CARRAZANA 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 1:907 N CENTRAL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5002
Mailing Address - Country:US
Mailing Address - Phone:407-846-2050
Mailing Address - Fax:407-846-0338
Practice Address - Street 1:907 N CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5002
Practice Address - Country:US
Practice Address - Phone:407-846-2050
Practice Address - Fax:407-846-0338
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15309207R00000X
FLACN450207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI24153Medicare UPIN
PR0022892Medicare PIN