Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | ME 94160 | FL |
NPI | 1013922749 |
---|---|
Provider Name | Dr. Edward S Pereira |
First Address | Jacksonville, FL 32216-4246 |
Second Address | Jacksonville, FL 32216-4246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2006 |
Last Update Date | 09/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
274080000 | (05) | FL |
30173 | BCBS (01) | FL |
H65595 | (02) | FL |
P00275053 | RAILROAD MEDICARE (01) | FL |