Provider Demographics
NPI:1720196322
Name:PERWIEN, JONATHAN MELTZ (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MELTZ
Last Name:PERWIEN
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 1:8100 ROYAL PALM BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5733
Mailing Address - Country:US
Mailing Address - Phone:954-344-2288
Mailing Address - Fax:333-052-3758
Practice Address - Street 1:8100 ROYAL PALM BLVD STE 105
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5733
Practice Address - Country:US
Practice Address - Phone:954-344-2288
Practice Address - Fax:954-344-8443
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055360207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10850WMedicare ID - Type Unspecified
E73162Medicare UPIN