Healthcare Provider Details

I. General information

NPI: 1073348322
Provider Name (Legal Business Name): JORGE DAVID PEREZ D'ERAMO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 CAMPO SANO AVE
CORAL GABLES FL
33146-1100
US

IV. Provider business mailing address

PO BOX 100905
ATLANTA GA
30384-0905
US

V. Phone/Fax

Practice location:
  • Phone: 786-268-6200
  • Fax: 786-533-9978
Mailing address:
  • Phone: 786-662-7980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberPA9119164
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberPA9119164
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberPA9119164
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA9119164
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9119164
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: