Provider Demographics
NPI:1619585510
Name:PEREZ, KRISTOPHER ALEXANDER (MD, PMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:ALEXANDER
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD, PMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:998 27TH STREET OCEAN
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-4214
Mailing Address - Country:US
Mailing Address - Phone:305-989-5246
Mailing Address - Fax:
Practice Address - Street 1:19605 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7724
Practice Address - Country:US
Practice Address - Phone:786-776-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME165990207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program