=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427367077
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOBSE I LEBRON PEREZ M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2010
-----------------------------------------------------
Last Update Date | 10/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 320 W FLETCHER AVE STE 101
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33612-3400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-374-9266
-----------------------------------------------------
Fax | 813-374-9267
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 850001, DEPT 8340
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32885-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-536-7277
-----------------------------------------------------
Fax | 855-830-1722
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | ACN765
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 18015
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------
=====================================================
Proprietary Identifiers Ever Reported
=====================================================
Identifier #1
-----------------------------------------------------
Identifier Code | 106911900
-----------------------------------------------------
Identifier Type | MEDICAID
-----------------------------------------------------
Identifier State | FL
-----------------------------------------------------
Identifier Issuer | Florida Medicaid Provider ID
-----------------------------------------------------