Provider Demographics
NPI:1255313573
Name:PEREZ, GERARDO MIGUEL (MD)
Entity type:Individual
Prefix:
First Name:GERARDO
Middle Name:MIGUEL
Last Name:PEREZ
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 1:777 EAST 25 STREET
Mailing Address - Street 2:SUITE 414
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3835
Mailing Address - Country:US
Mailing Address - Phone:305-835-7588
Mailing Address - Fax:305-835-6372
Practice Address - Street 1:777 EAST 25 STREET
Practice Address - Street 2:SUITE 414
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3835
Practice Address - Country:US
Practice Address - Phone:305-835-7588
Practice Address - Fax:305-835-6372
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46223207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96858Medicare ID - Type Unspecified
FLD64010Medicare UPIN