Provider Demographics
NPI:1215130943
Name:PEREZ, HUMBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:HUMBERTO
Middle Name:
Last Name:PEREZ
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 1:10101 HAMLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776-1046
Mailing Address - Country:US
Mailing Address - Phone:813-766-0912
Mailing Address - Fax:
Practice Address - Street 1:6450 38TH AVE N STE 300
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1649
Practice Address - Country:US
Practice Address - Phone:727-300-1845
Practice Address - Fax:727-800-9308
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65613207RG0300X, 207RG0300X
NY189678207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME65613OtherME65613
FL000181200Medicaid
FLME65613OtherLICENSE
FL26337SMedicare Oscar/Certification