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General NPI Number Information
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NPI Number | 1144496068
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Entity Type | Organization
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Legal Business Name | MARIO R PEREZ MD PA
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 2075 MAIN ST SUITE#1A
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City | SARASOTA
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State | FL
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Zip | 34237-6057
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Country | US
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Telephone | 941-914-3310
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Fax | 941-316-0185
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Provider Business Mailing Address
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Address Line | 2075 MAIN ST SUITE#1A
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City | SARASOTA
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State | FL
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Zip | 34237-6057
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Country | US
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Telephone | 941-914-3310
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Fax | 941-316-0185
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Authorized Official
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Title or Position | OWNER/PHYCIAN
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Name | DR. MARIO R PEREZ
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Credential | MD
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Telephone | 941-914-3310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME72969
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License Number State | FL
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