Healthcare Provider Details

I. General information

NPI: 1497937338
Provider Name (Legal Business Name): ROBERTO PEREZ-MILLAN, MD, P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 N. HABANA SUITE 28
TAMPA FL
33614-7123
US

IV. Provider business mailing address

4600 N. HABANA SUITE 28
TAMPA FL
33614-7123
US

V. Phone/Fax

Practice location:
  • Phone: 813-873-2800
  • Fax: 813-873-2811
Mailing address:
  • Phone: 813-873-2800
  • Fax: 813-873-2811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME88669
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME88669
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME88669
License Number State

VIII. Authorized Official

Name: ROBERTO PEREZ-MILLAN, M.D.
Title or Position: PRESIDENT/PHYSICIAN
Credential: MD
Phone: 813-873-2800