Provider Demographics
NPI:1760478739
Name:PEREZ, GABRIEL (MD)
Entity Type:Individual
Prefix:
First Name:GABRIEL
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 1:4519 GEORGE RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7329
Mailing Address - Country:US
Mailing Address - Phone:813-496-1075
Mailing Address - Fax:
Practice Address - Street 1:17240 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-8978
Practice Address - Country:US
Practice Address - Phone:352-754-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76742207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050080013Medicare PIN
FLCH6637Medicare PIN
FLE2311YMedicare PIN