Provider Demographics
NPI:1962869941
Name:PEREZ, JORGE (MD)
Entity type:Individual
Prefix:
First Name:JORGE
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 1:14261 SW 120TH ST STE 112
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7273
Mailing Address - Country:US
Mailing Address - Phone:305-378-1302
Mailing Address - Fax:305-383-5314
Practice Address - Street 1:14261 SW 120TH ST STE 112
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7273
Practice Address - Country:US
Practice Address - Phone:305-378-1302
Practice Address - Fax:305-383-5314
Is Sole Proprietor?:No
Enumeration Date:2016-01-22
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME140478207RC0000X
FLTRN22555390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME140478OtherFLORIDA MEDICAL LICENSE
390451OtherAMERICAN BOARD OF INTERNAL MEDICINE