Healthcare Provider Details

I. General information

NPI: 1841530649
Provider Name (Legal Business Name): MARCO ANTONIO PEREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 DEL PRADO BLVD S
CAPE CORAL FL
33990-2668
US

IV. Provider business mailing address

11001 62ND DR APT 11C
FOREST HILLS NY
11375-1283
US

V. Phone/Fax

Practice location:
  • Phone: 239-424-3123
  • Fax: 239-424-4140
Mailing address:
  • Phone: 917-407-1013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2016-0243
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD2016-0243
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME129797
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: