Provider Demographics
NPI:1689836348
Name:PEREZ, RICARDO LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:LUIS
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9780 E INDIGO ST
Mailing Address - Street 2:STE 204
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5610
Mailing Address - Country:US
Mailing Address - Phone:305-804-7947
Mailing Address - Fax:
Practice Address - Street 1:11373 SW 211TH ST
Practice Address - Street 2:SUITE 16
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33189-2245
Practice Address - Country:US
Practice Address - Phone:305-234-0009
Practice Address - Fax:305-234-8688
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME109154207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003835700Medicaid
FL003835700Medicaid