Provider Demographics
NPI:1689836348
Name:PEREZ, RICARDO LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:LUIS
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11540 SW 80TH RD
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-4405
Mailing Address - Country:US
Mailing Address - Phone:305-298-3077
Mailing Address - Fax:786-288-3595
Practice Address - Street 1:11540 SW 80TH RD
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-4405
Practice Address - Country:US
Practice Address - Phone:305-298-3077
Practice Address - Fax:786-288-3595
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109154207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003835700Medicaid
FL003835700Medicaid