MEDICARE: DR. MARK DAVID PEREZ MD

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	207Q00000X	Family Medicine Physician	ME130601	FL
2	207Q00000X	Family Medicine Physician	9700706	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	080192422	OTHER	NC	RAILROAD MEDICARE
6	080185873	OTHER	NC	RAILROAD MEDICARE

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
2	C3864	OTHER	NC	MEDCOST
3	1306J	OTHER	NC	BCBS
5	39-01069	OTHER	NC	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1396740783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK DAVID PEREZ MD

Provider Business Mailing Address
First Line	:	PO BOX 936857
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31193-6857
Country	:	US
Telephone Number	:	910-662-6600
Fax Number	:	910-332-0246

Provider Business Practice Location Address
First Line	:	3601 W COMMERCIAL BLVD STE 20
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3334
Country	:	US
Telephone Number	:	954-368-4560
Fax Number	:	954-530-6418

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	05/26/2021

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Directions to “ DR. MARK DAVID PEREZ MD” Practice Location

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