Healthcare Provider Details

I. General information

NPI: 1124022546
Provider Name (Legal Business Name): OSCAR PEREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14310 N DALE MABRY HWY STE 305
TAMPA FL
33618-2059
US

IV. Provider business mailing address

14310 N DALE MABRY HWY STE 305
TAMPA FL
33618-2059
US

V. Phone/Fax

Practice location:
  • Phone: 813-615-7028
  • Fax: 813-615-8008
Mailing address:
  • Phone: 813-615-7028
  • Fax: 813-615-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberME0061377
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME61377
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: