MEDICARE: DR. LEO A PEREZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME46540	FL
2	208U00000X	Clinical Pharmacology Physician	ME46540	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00036015	OTHER	FL	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1366445512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEO A PEREZ M.D.

Provider Business Mailing Address
First Line	:	8732 SOMERSWORTH PLACE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-1029
Country	:	US
Telephone Number	:	813-887-5722
Fax Number	:

Provider Business Practice Location Address
First Line	:	8732 SOMERSWORTH PLACE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-1029
Country	:	US
Telephone Number	:	813-887-5722
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/15/2015

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