Healthcare Provider Details

I. General information

NPI: 1801174453
Provider Name (Legal Business Name): ESMIL PEREZ CHAVEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 FALCONSGATE AVE
DAVIE FL
33331-2926
US

IV. Provider business mailing address

6200 FALCONSGATE AVE
DAVIE FL
33331-2926
US

V. Phone/Fax

Practice location:
  • Phone: 240-676-5724
  • Fax: 786-360-2509
Mailing address:
  • Phone: 240-676-5724
  • Fax: 786-360-2509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME112118
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: