Provider Demographics
NPI:1700867553
Name:PEREZ, ROBERTO S (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:S
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 1:202 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4148
Mailing Address - Country:US
Mailing Address - Phone:407-889-4711
Mailing Address - Fax:407-889-7742
Practice Address - Street 1:202 N PARK AVE
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4148
Practice Address - Country:US
Practice Address - Phone:407-889-4711
Practice Address - Fax:407-889-7742
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60096207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL080129918OtherRAILROAD MEDICARE
FL12484YOtherMEDICARE
FL053958900Medicaid
FL12484WMedicare PIN
FL12484YOtherMEDICARE
FLK9529OtherMEDICARE GROUP NUMBER
FL12484WMedicare PIN
FL12484YOtherMEDICARE
FL40471OtherMEDICARE GROUP NUMBER