Provider Demographics
NPI:1942660410
Name:PEREZ, GLORIA JORDAN (DO)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:JORDAN
Last Name:PEREZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:
Other - Last Name:JORDAN PETRIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:8812 LAKE GLONA CT
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8332
Mailing Address - Country:US
Mailing Address - Phone:352-516-2629
Mailing Address - Fax:
Practice Address - Street 1:1900 DON WICKHAM DR STE 130
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1979
Practice Address - Country:US
Practice Address - Phone:352-241-7050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16861207VX0000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1942660410OtherNPI