Individual
GARY CHARLES PEREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
550 REDSTONE AVE W, SUITE 370, CRESTVIEW, FL 32536-6428
(850) 682-2209
(850) 850-6822
Mailing address
550 REDSTONE AVE W, SUITE 370, CRESTVIEW, FL 32536-6428
(850) 682-2209
(850) 850-6822
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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