MEDICARE: SUNCOAST PREMIER MEDICAL LLC

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	207R00000X	Internal Medicine Physician	ME72969	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	:	1427206739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNCOAST PREMIER MEDICAL LLC

Provider Business Mailing Address
First Line	:	40107 HIGHWAY 27 FL 2
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-5901
Country	:	US
Telephone Number	:	352-243-3555
Fax Number	:	352-243-6614

Provider Business Practice Location Address
First Line	:	40107 HIGHWAY 27 FL 2
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-5901
Country	:	US
Telephone Number	:	352-243-3555
Fax Number	:	352-243-6614

Authorized Official
Title or Position	:	OWNER
Name	:	MARIO RENE PEREZ
Credential	:	M.D.
Telephone Number	:	863-207-6554

Provider Enumeration Date	:	08/29/2008
Last Update Date	:	12/09/2025

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Directions to “SUNCOAST PREMIER MEDICAL LLC ” Practice Location

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