MEDICARE: DR. AIXSA 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	01049434A	IN
2	208D00000X	General Practice Physician	ACN1112	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639171853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AIXSA PEREZ M.D.

Provider Business Mailing Address
First Line	:	1302 RIVER ST
Second Line	:
City	:	PALATKA
State	:	FL
Zip	:	32177-5042
Country	:	US
Telephone Number	:	386-328-0108
Fax Number	:	386-325-1086

Provider Business Practice Location Address
First Line	:	1425 DUNN AVE
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-1439
Country	:	US
Telephone Number	:	386-323-9600
Fax Number	:	386-323-9695

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	02/25/2026

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