Provider Demographics
NPI:1528052420
Name:PEREZ-RODRIGUEZ, MARIO RENE (MD)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:RENE
Last Name:PEREZ-RODRIGUEZ
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:PO BOX 470459
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-0459
Mailing Address - Country:US
Mailing Address - Phone:352-243-3555
Mailing Address - Fax:352-243-6614
Practice Address - Street 1:1239 US HIGHWAY 27
Practice Address - Street 2:FOUR CORNERS AREA
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-8910
Practice Address - Country:US
Practice Address - Phone:352-243-3555
Practice Address - Fax:352-243-6614
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72969207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277533600Medicaid
FL47211OtherBCBS
FL600001577OtherTAX ID
FLK2472AOtherMEDICARE GROUP NUMBER
FLG99597Medicare UPIN
FL47211OtherBCBS
FL277533600Medicaid