Provider Demographics
NPI:1780681585
Name:PEREZ, SERGIO J (MD)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:J
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 1:7005 CORTEZ RD W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-2509
Mailing Address - Country:US
Mailing Address - Phone:941-752-2700
Mailing Address - Fax:941-752-2730
Practice Address - Street 1:3501 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3196
Practice Address - Country:US
Practice Address - Phone:941-752-2700
Practice Address - Fax:941-752-2730
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79712207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280624000Medicaid
FLH28401Medicare UPIN
FL62869YMedicare PIN