Healthcare Provider Details

I. General information

NPI: 1972072445
Provider Name (Legal Business Name): VICTOR S DJURO PEREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S ORANGE AVE # MP780
ORLANDO FL
32806-2134
US

IV. Provider business mailing address

1400 S ORANGE AVE # MP780
ORLANDO FL
32806-2134
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-7477
  • Fax: 407-423-0840
Mailing address:
  • Phone: 321-841-7477
  • Fax: 407-423-0840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: