Provider Demographics
NPI:1215911011
Name:PEREZ-RODRIGUEZ, SOCRATES (MD)
Entity type:Individual
Prefix:
First Name:SOCRATES
Middle Name:
Last Name:PEREZ-RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SOCRATES
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7211 155TH PL N
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418
Mailing Address - Country:US
Mailing Address - Phone:561-746-4462
Mailing Address - Fax:
Practice Address - Street 1:1855 VETERANS PARK DR
Practice Address - Street 2:STE 103
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0446
Practice Address - Country:US
Practice Address - Phone:239-331-5114
Practice Address - Fax:239-631-5349
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86412207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001558400Medicaid
FL71148YMedicare PIN