Healthcare Provider Details

I. General information

NPI: 1154397461
Provider Name (Legal Business Name): JOSE H PEREZ SUAREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 E COLLINS ST
UMATILLA FL
32784-8383
US

IV. Provider business mailing address

16140 US HIGHWAY 441
EUSTIS FL
32726-6508
US

V. Phone/Fax

Practice location:
  • Phone: 352-483-7984
  • Fax: 352-589-6496
Mailing address:
  • Phone: 352-483-7984
  • Fax: 352-589-6496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME005628
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME56328
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: