Provider Demographics
NPI:1659460764
Name:PEREZ, RUBEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:
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 1:4382 LB MCLEOD RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811
Mailing Address - Country:US
Mailing Address - Phone:407-648-0076
Mailing Address - Fax:407-648-3666
Practice Address - Street 1:4382 LB MCLEOD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811
Practice Address - Country:US
Practice Address - Phone:407-648-0076
Practice Address - Fax:407-648-3666
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL45888207Q00000X
FLME45888207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02433Medicare PIN
FLC77124Medicare UPIN