Provider Demographics
NPI:1588659205
Name:PERELMAN, JASON DANIEL
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:DANIEL
Last Name:PERELMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:MANAGED CARE DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:8890 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7235
Practice Address - Country:US
Practice Address - Phone:954-748-4771
Practice Address - Fax:954-748-6755
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87298208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0187660OtherGHI
FL1193452OtherWELLCARE
FL32346OtherUNIVERSAL HEALTHCARE
FL7825440OtherAETNA PROVIDER #
FLP0003182OtherFLORIDA HEALTHCARE PLUS
FL400016577003OtherPREFERRED CARE PARTNERS
FL78819OtherBCBS FL
FLP01709697OtherSIMPLY HEALTHCARE
FL273032400Medicaid
FL400016577001OtherPREFERRED CARE PARTNERS
FL400016577002OtherPREFERRED CARE PARTNERS
FL77215OtherGROUP PTAN
FLP00474379OtherRR MEDICARE
FL400016577000OtherPREFERRED CARE PARTNERS
FL78819VMedicare PIN
FLH84954Medicare UPIN