Provider Demographics
NPI:1013959246
Name:PEREZ-TIRSE, JOSE (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:PEREZ-TIRSE
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:PO BOX 831706
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33283-1706
Mailing Address - Country:US
Mailing Address - Phone:786-973-5524
Mailing Address - Fax:305-675-0662
Practice Address - Street 1:11760 SW 40TH ST
Practice Address - Street 2:SUITE 502
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3582
Practice Address - Country:US
Practice Address - Phone:786-973-5524
Practice Address - Fax:305-675-0662
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63851207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23124XOtherMEDICARE PTAN
FL378108900Medicaid
FL23124XOtherMEDICARE PTAN