Healthcare Provider Details

I. General information

NPI: 1740288240
Provider Name (Legal Business Name): RICARDO E PEREZ-MONTERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 US HIGHWAY 98 S SUITE 102
LAKELAND FL
33812-4254
US

IV. Provider business mailing address

PO BOX 1387
HIGHLAND CITY FL
33846-1387
US

V. Phone/Fax

Practice location:
  • Phone: 863-646-9191
  • Fax: 863-646-5252
Mailing address:
  • Phone: 863-646-9191
  • Fax: 863-646-5252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME-72440
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: