Healthcare Provider Details

I. General information

NPI: 1235178567
Provider Name (Legal Business Name): NELSON PEREIRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 LYONS RD
COCONUT CREEK FL
33063-3900
US

IV. Provider business mailing address

3191 CORAL WAY SUITE 303
CORAL GABLES FL
33145-3213
US

V. Phone/Fax

Practice location:
  • Phone: 954-971-2266
  • Fax: 305-461-5911
Mailing address:
  • Phone: 305-461-6060
  • Fax: 305-461-5911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0044944
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: