Provider Demographics
NPI:1598966996
Name:PEREZ, EDUARDO ALFONSO (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:ALFONSO
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 1:8940 N KENDALL DR
Mailing Address - Street 2:SUITE # 603E
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2148
Mailing Address - Country:US
Mailing Address - Phone:305-243-2247
Mailing Address - Fax:305-243-5731
Practice Address - Street 1:8940 N KENDALL DR
Practice Address - Street 2:SUITE # 603E
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2148
Practice Address - Country:US
Practice Address - Phone:305-243-2247
Practice Address - Fax:305-243-5731
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME927722086S0120X
TXN0362208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0037292-00Medicaid
FL0037292-00Medicaid