Individual
DR. MARIETTE LEE PEIRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Mailing address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
ME80327
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
290013910
RAILROAD MEDICARE
FL
01
—
58929
BLUECROSS/BLUESHIELD
FL
Enumeration date
10/22/2005
Last updated
11/21/2012
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