=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609945294
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY ROBERT PERELMAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2006
-----------------------------------------------------
Last Update Date | 05/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 98 S FEDERAL HWY
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33432-4825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-620-4798
-----------------------------------------------------
Fax | 561-338-2476
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 98 S FEDERAL HWY
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33432-4825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-542-5933
-----------------------------------------------------
Fax | 561-338-2476
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME51866
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 051866
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------