Provider Demographics
NPI:1396740783
Name:PEREZ, MARK DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:910-662-6600
Mailing Address - Fax:910-332-0246
Practice Address - Street 1:3601 W COMMERCIAL BLVD STE 20
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3334
Practice Address - Country:US
Practice Address - Phone:954-368-4560
Practice Address - Fax:954-530-6418
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME130601207Q00000X
NC9700706207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891306JMedicaid
NCC3864OtherMEDCOST
NC1306JOtherBCBS
NC080192422OtherRAILROAD MEDICARE
NC39-01069OtherUNITED HEALTHCARE
NC080185873OtherRAILROAD MEDICARE
NC2261472AMedicare PIN
NC39-01069OtherUNITED HEALTHCARE
NC2261472BMedicare PIN