Healthcare Provider Details

I. General information

NPI: 1881641199
Provider Name (Legal Business Name): JORGE C PEREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 SW 1ST ST
MIAMI FL
33135-2402
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 305-324-2000
  • Fax: 305-461-5911
Mailing address:
  • Phone: 305-500-2000
  • Fax: 305-667-1275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME0057463
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0057463
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: