Provider Demographics
NPI:1578234571
Name:PEREZ, KEVIN ALEXANDER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:ALEXANDER
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:4371 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:1708 CAPE CORAL PKWY W STE 10
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-6985
Practice Address - Country:US
Practice Address - Phone:239-541-4633
Practice Address - Fax:239-541-1825
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9114989363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical