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General NPI Number Information
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NPI Number | 1154512358
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Entity Type | Individual
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Provider Name | GARY CHARLES PEREZ PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 02/09/2012
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Provider Practice Location Address
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Address Line | 550 REDSTONE AVE W SUITE 370
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City | CRESTVIEW
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State | FL
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Zip | 32536-6428
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Country | US
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Telephone | 850-682-2209
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Fax | 850-850-6822
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Provider Business Mailing Address
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Address Line | 550 REDSTONE AVE W SUITE 370
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City | CRESTVIEW
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State | FL
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Zip | 32536-6428
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Country | US
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Telephone | 850-682-2209
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Fax | 850-850-6822
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 9103949
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License Number State | FL
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