Provider Demographics
NPI:1790908564
Name:PEREZ, ALEXANDER G (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:G
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 1:14031 SW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7036
Mailing Address - Country:US
Mailing Address - Phone:305-788-0999
Mailing Address - Fax:305-412-6686
Practice Address - Street 1:8720 N KENDALL DR
Practice Address - Street 2:STE 211
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2299
Practice Address - Country:US
Practice Address - Phone:305-788-0999
Practice Address - Fax:305-412-6686
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 975802084N0400X, 2084P0804X
VA01012710112084P0800X
NC2020-043852084P0800X
FLMD 975802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001253300Medicaid
FLCD760ZMedicare PIN
FLCD760YMedicare PIN
FLCD760XMedicare PIN