Provider Demographics
NPI:1851339824
Name:PERITO, PAUL E (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:PERITO
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 1:135 SAN LORENZO AVE STE 540
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1880
Mailing Address - Country:US
Mailing Address - Phone:305-444-2920
Mailing Address - Fax:305-446-9377
Practice Address - Street 1:135 SAN LORENZO AVE STE 540
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1880
Practice Address - Country:US
Practice Address - Phone:305-444-2920
Practice Address - Fax:305-446-9377
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060097174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377778200Medicaid
FLF98245Medicare UPIN