MEDICARE: DANIEL ALEJANDRO PERDICARO PA-C

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	363A00000X	Physician Assistant	PA9104434	FL

General Provider Information

NPI Number	:	1922282672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL ALEJANDRO PERDICARO PA-C

Provider Business Mailing Address
First Line	:	4790 BARKLEY CIR # A
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-7543
Country	:	US
Telephone Number	:	239-275-8882
Fax Number	:	239-939-1330

Provider Business Practice Location Address
First Line	:	4790 BARKLEY CIR # A
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-7543
Country	:	US
Telephone Number	:	239-275-8882
Fax Number	:	239-939-1330

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

Provider Enumeration Date	:	12/18/2007
Last Update Date	:	12/19/2007

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