Healthcare Provider Details

I. General information

NPI: 1972917334
Provider Name (Legal Business Name): MARTA J PEREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 PRUDENTIAL DR STE 1800
JACKSONVILLE FL
32207-8345
US

IV. Provider business mailing address

836 PRUDENTIAL DR STE 1800
JACKSONVILLE FL
32207-8345
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-7684
  • Fax: 314-747-1429
Mailing address:
  • Phone: 904-398-7684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2020000357
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberME147407
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: