Provider Demographics
NPI:1649234808
Name:PEREZ-STABLE, EDUARDO LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:LUIS
Last Name:PEREZ-STABLE
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 1:4510 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3516
Mailing Address - Country:US
Mailing Address - Phone:954-893-8900
Mailing Address - Fax:954-893-8992
Practice Address - Street 1:4510 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3516
Practice Address - Country:US
Practice Address - Phone:954-893-8900
Practice Address - Fax:954-416-6633
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83969207Q00000X
FLPA9102145207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL592466190OtherMEMORIAL PRIMARY
FL13714YOtherBLUE CROSS
FLG596OtherSUMMIT HEALTH PLAN
134706OtherAETNA
178521OtherJMH
592466190OtherMEMORIAL MANAGED CARE
8636837OtherCIGNA HEALTH PLAN
FLSG07396OtherVISTA HEALTH PLAN
FLH62006Medicare UPIN
FLG596OtherSUMMIT HEALTH PLAN