Provider Demographics
NPI:1609925262
Name:PEREZ, JORGE L (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:L
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1385 CORAL WAY
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2941
Mailing Address - Country:US
Mailing Address - Phone:305-854-3307
Mailing Address - Fax:305-854-3130
Practice Address - Street 1:1385 CORAL WAY
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2941
Practice Address - Country:US
Practice Address - Phone:305-854-3307
Practice Address - Fax:305-854-3130
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 34153174400000X
FLME34153207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066152000Medicaid
FL066152000Medicaid
FL95736CMedicare ID - Type Unspecified