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Individual
GARY CHARLES PEREZ
Active
Individual
GARY CHARLES PEREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA 9103949
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002879600
—
FL
01
—
1467589010
MEDICARE NPI GROUP
FL
05
—
1467589010
—
FL
01
—
592921954
TAX ID MEDICARE GROUP
—
01
—
PA9103949
PA LICENSE
—
Enumeration date
08/05/2007
Last updated
02/09/2012
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