Provider Demographics
NPI:1740288240
Name:PEREZ-MONTERO, RICARDO E (MD)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:E
Last Name:PEREZ-MONTERO
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 1387
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33846-1387
Mailing Address - Country:US
Mailing Address - Phone:863-646-9191
Mailing Address - Fax:863-646-5252
Practice Address - Street 1:4725 US HIGHWAY 98 S
Practice Address - Street 2:SUITE 102
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812-4254
Practice Address - Country:US
Practice Address - Phone:863-646-9191
Practice Address - Fax:863-646-5252
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-72440207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL203393017OtherTAX ID
FLME0072440OtherMEDICAL LICENSE
FLME0072440OtherMEDICAL LICENSE