Provider Demographics
NPI:1013922749
Name:PEREIRA, EDWARD S (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:S
Last Name:PEREIRA
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 1:3550 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE 302
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4246
Mailing Address - Country:US
Mailing Address - Phone:904-733-4444
Mailing Address - Fax:
Practice Address - Street 1:3550 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE 302
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4246
Practice Address - Country:US
Practice Address - Phone:904-733-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 94160207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30173OtherBCBS
FL274080000Medicaid
FLP00275053OtherRAILROAD MEDICARE
FLH65595Medicare UPIN
FL30173YMedicare PIN
FL30173ZMedicare PIN
FL30173XMedicare PIN