Provider Demographics
NPI:1821067299
Name:PEREZ, JAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1602 ALTON RD
Mailing Address - Street 2:PMB 84
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-2421
Mailing Address - Country:US
Mailing Address - Phone:305-836-6646
Mailing Address - Fax:305-836-4722
Practice Address - Street 1:777 E 25TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3825
Practice Address - Country:US
Practice Address - Phone:305-836-6646
Practice Address - Fax:305-836-4722
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME55359207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052964800Medicaid
FL052964800Medicaid
FL09777Medicare PIN