Provider Demographics
NPI:1528086196
Name:PEREZ, JAIME (MD)
Entity type:Individual
Prefix:DR
First Name:JAIME
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 1:307 S MACDILL AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3141
Mailing Address - Country:US
Mailing Address - Phone:813-877-3739
Mailing Address - Fax:813-877-3738
Practice Address - Street 1:307 S MACDILL AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3141
Practice Address - Country:US
Practice Address - Phone:813-877-3739
Practice Address - Fax:813-877-3738
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME731722082S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2373861OtherAETNA US HEALTHCARE HMO
FL58077OtherBLUE CROSS & BLUE SHIELD
FL7227174OtherAETNA US HEALTHCARE PPO/M
FL58077OtherBLUE CROSS & BLUE SHIELD
FL7227174OtherAETNA US HEALTHCARE PPO/M