MEDICARE: ARLES PERDOMO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	ME87444	FL
2	208D00000X	General Practice Physician	ME87444	FL
3	207Q00000X	Family Medicine Physician	ME874444	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033218821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARLES PERDOMO

Provider Business Mailing Address
First Line	:	3677 CENTRAL AVE STE I
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8226
Country	:	US
Telephone Number	:	239-944-0918
Fax Number	:	239-237-5165

Provider Business Practice Location Address
First Line	:	3677 CENTRAL AVE STE I
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8226
Country	:	US
Telephone Number	:	239-944-0918
Fax Number	:	239-237-5165

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	04/06/2023

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Directions to “ ARLES PERDOMO ” Practice Location

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