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NPI Code Detail

MEDICARE: DR. EDUARDO LUIS PEREZ-STABLE MD

MEDICARE: DR. EDUARDO LUIS PEREZ-STABLE 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
1207Q00000XFamily Medicine PhysicianME83969FL
2207Q00000XFamily Medicine PhysicianPA9102145FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1592466190OTHERFLMEMORIAL PRIMARY
213714YOTHERFLBLUE CROSS
3G596OTHERFLSUMMIT HEALTH PLAN
4134706OTHERAETNA
5178521OTHERJMH
6592466190OTHERMEMORIAL MANAGED CARE
78636837OTHERCIGNA HEALTH PLAN
8SG07396OTHERFLVISTA HEALTH PLAN

General Provider Information

NPI Number : 1649234808
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDUARDO LUIS PEREZ-STABLE MD
Provider Business Mailing Address
First Line : 4510 SHERIDAN ST
Second Line :
City : HOLLYWOOD
State : FL
Zip : 33021-3516
Country : US
Telephone Number : 954-893-8900
Fax Number : 954-893-8992
Provider Business Practice Location Address
First Line : 4510 SHERIDAN ST
Second Line :
City : HOLLYWOOD
State : FL
Zip : 33021-3516
Country : US
Telephone Number : 954-893-8900
Fax Number : 954-416-6633
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2006
Last Update Date : 03/26/2021

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