Provider Demographics
NPI:1902301377
Name:PEREZ, JOSE RAUL (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:RAUL
Last Name:PEREZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 W 20TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1813
Mailing Address - Country:US
Mailing Address - Phone:305-822-0401
Mailing Address - Fax:305-824-1748
Practice Address - Street 1:7100 W 20TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1813
Practice Address - Country:US
Practice Address - Phone:305-822-0401
Practice Address - Fax:305-824-1748
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME166412207XX0005X
FL166412208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice