MEDICARE: GERARDO C PEREZ D.O.

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	OS0004878	FL

General Provider Information

NPI Number	:	1396732038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERARDO C PEREZ D.O.

Provider Business Mailing Address
First Line	:	3435 NE 163RD ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33160-4426
Country	:	US
Telephone Number	:	305-947-3700
Fax Number	:	305-947-9610

Provider Business Practice Location Address
First Line	:	3435 NE 163RD ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33160-4426
Country	:	US
Telephone Number	:	305-947-3700
Fax Number	:	305-947-9610

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	07/13/2022

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