Healthcare Provider Details

I. General information

NPI: 1457348153
Provider Name (Legal Business Name): EDWARD A PEREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 S ANDREWS AVE FL 2
FT LAUDERDALE FL
33316-2509
US

IV. Provider business mailing address

1700 NW 49TH ST STE 125
FT LAUDERDALE FL
33309-3750
US

V. Phone/Fax

Practice location:
  • Phone: 954-355-3490
  • Fax: 954-355-3498
Mailing address:
  • Phone: 954-355-3490
  • Fax: 954-355-3498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number35461
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: