Individual
DR. MARK NICHOLAS PERENICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6536 GUNN HWY., TAMPA, FL 33625-3853
(813) 803-0029
(813) 949-8919
Mailing address
7702 STILL PARK CIR, ODESSA, FL 33556-2263
(813) 803-0029
(813) 949-8919
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
OS14036
FL
207XS0117X
Orthopaedic Surgery of the Spine Physician
Q3421
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103265500
—
FL
01
—
OS14036
MEDICAL LICENSE
FL
01
—
VJSQK
BLUE CROSS
FL
Enumeration date
08/13/2010
Last updated
03/16/2021
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