Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | ACN800 | FL |
Y | 208D00000X | General Practice Physician | 15643 | PR |
NPI | 1255354841 |
---|---|
Provider Name | Dr. Omar V Perez Soto |
First Address | Davenport, FL 33837-3962 |
Second Address | San Sebastian, PR 00685 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 12/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0022909 | PROVIDER NUMBER (01) | PR |
I28949 | (02) | PR |