# GARY CHARLES PEREZ

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1154512358
- **Gender:** Man
- **Credential:** PHYSICIAN ASSISTANT

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA 9103949 | FL | Yes |

## Other

- **Enumeration date:** 08/05/2007
- **Last updated:** 02/09/2012

## 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 | — |