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General NPI Number Information
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NPI Number | 1679679872
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Entity Type | Organization
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Legal Business Name | ERNESTO J PEREZ MD LLC
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 08/30/2010
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Provider Practice Location Address
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Address Line | 1450 6TH STREET SE
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City | WINTER HAVEN
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State | FL
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Zip | 33880-4505
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Country | US
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Telephone | 863-299-1485
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Fax | 863-291-3572
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Provider Business Mailing Address
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Address Line | 1450 6TH STREET SE
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City | WINTER HAVEN
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State | FL
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Zip | 33880-4505
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Country | US
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Telephone | 863-299-1485
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Fax | 863-291-3572
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Authorized Official
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Title or Position | OWNER
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Name | ERNESTO J PEREZ
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Credential | MD
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Telephone | 863-299-1485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | ME0055358
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License Number State | FL
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