Healthcare Provider Details

I. General information

NPI: 1417510298
Provider Name (Legal Business Name): JIODANY PEREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5966 S DIXIE HWY STE 401
SOUTH MIAMI FL
33143-5177
US

IV. Provider business mailing address

4300 ALTON RD
MIAMI BEACH FL
33140-2948
US

V. Phone/Fax

Practice location:
  • Phone: 786-453-2667
  • Fax:
Mailing address:
  • Phone: 305-409-3901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME151714
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberME151714
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME151714
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: