Provider Demographics
NPI:1154397461
Name:PEREZ SUAREZ, JOSE H (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:H
Last Name:PEREZ SUAREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16140 US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6508
Mailing Address - Country:US
Mailing Address - Phone:352-483-7984
Mailing Address - Fax:352-589-6496
Practice Address - Street 1:249 E COLLINS ST
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:FL
Practice Address - Zip Code:32784-8383
Practice Address - Country:US
Practice Address - Phone:352-483-7984
Practice Address - Fax:352-589-6496
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME005628207Q00000X
FLME56328207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061377100Medicaid
FLD34266Medicare UPIN