Provider Demographics
NPI:1609012749
Name:JAVIER PEREZ MD PA
Entity Type:Organization
Organization Name:JAVIER PEREZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-836-6646
Mailing Address - Street 1:1602 ALTON ROAD
Mailing Address - Street 2:PMB # 84
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-2421
Mailing Address - Country:US
Mailing Address - Phone:305-836-6646
Mailing Address - Fax:305-836-6646
Practice Address - Street 1:777 E 25TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3825
Practice Address - Country:US
Practice Address - Phone:305-836-6646
Practice Address - Fax:305-836-4722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-19
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55359207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052964800Medicaid
FL09777ZMedicare PIN
FL09777Medicare PIN
FL052964800Medicaid
FLBI186Medicare PIN