Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | ME92772 | FL |
NPI | 1598966996 |
---|---|
Provider Name | Eduardo Alfonso Perez |
First Address | Miami, FL 33176-2148 |
Second Address | Miami, FL 33176-2148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 14/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0037292-00 | (05) | FL |