Provider Demographics
NPI:1447572912
Name:JORGE J. PEREZ, M.D., P.A.
Entity type:Organization
Organization Name:JORGE J. PEREZ, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HILDA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:DRAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-896-5741
Mailing Address - Street 1:1521 WOODWARD ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4112
Mailing Address - Country:US
Mailing Address - Phone:407-896-5741
Mailing Address - Fax:407-894-7756
Practice Address - Street 1:1521 WOODWARD ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4112
Practice Address - Country:US
Practice Address - Phone:407-896-5741
Practice Address - Fax:407-894-7756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME29853207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD64258Medicare UPIN