Provider Demographics
NPI:1124304746
Name:PEREZ SORI, ANGEL ARTURO (MD)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:ARTURO
Last Name:PEREZ SORI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 W AZEELE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3577
Mailing Address - Country:US
Mailing Address - Phone:813-251-0194
Mailing Address - Fax:813-254-0279
Practice Address - Street 1:3010 W AZEELE ST STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3577
Practice Address - Country:US
Practice Address - Phone:813-251-0194
Practice Address - Fax:813-254-0279
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 121644207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014806300Medicaid
FL014806300Medicaid