Provider Demographics
NPI:1679768501
Name:DE PERALTA, EDGAR TUGAOEN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:TUGAOEN
Last Name:DE PERALTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:255 EVERNIA ST APT 311
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5680
Mailing Address - Country:US
Mailing Address - Phone:888-464-2466
Mailing Address - Fax:410-740-1518
Practice Address - Street 1:529 S FLAGLER DR APT 6E
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-5927
Practice Address - Country:US
Practice Address - Phone:410-666-2588
Practice Address - Fax:410-740-1518
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 1076652084N0400X
NY2422972084N0400X
NY60242297390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program