Healthcare Provider Details

I. General information

NPI: 1851721963
Provider Name (Legal Business Name): JOSE JAVIER PEREZ MONTALVO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DR. JOSE J PEREZ

II. Dates (important events)

Enumeration Date: 11/26/2013
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 S TUTTLE AVE
SARASOTA FL
34239-2608
US

IV. Provider business mailing address

157 BALTIMORE ST STE 102
CUMBERLAND MD
21502-2472
US

V. Phone/Fax

Practice location:
  • Phone: 301-722-0484
  • Fax: 833-903-0130
Mailing address:
  • Phone: 301-722-0484
  • Fax: 833-903-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR0930
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number262337
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number030714R
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: