1649234808 NPI number — DR. EDUARDO LUIS PEREZ-STABLE MD

Table of content: DR. EDUARDO LUIS PEREZ-STABLE MD (NPI 1649234808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649234808 NPI number — DR. EDUARDO LUIS PEREZ-STABLE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEREZ-STABLE
Provider First Name:
EDUARDO
Provider Middle Name:
LUIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649234808
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4510 SHERIDAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLYWOOD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33021-3516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-893-8900
Provider Business Mailing Address Fax Number:
954-893-8992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4510 SHERIDAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33021-3516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-893-8900
Provider Business Practice Location Address Fax Number:
954-416-6633
Provider Enumeration Date:
04/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME83969 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: PA9102145 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 592466190 . This is a "MEMORIAL PRIMARY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 13714Y . This is a "BLUE CROSS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: G596 . This is a "SUMMIT HEALTH PLAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 134706 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 178521 . This is a "JMH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 592466190 . This is a "MEMORIAL MANAGED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8636837 . This is a "CIGNA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: SG07396 . This is a "VISTA HEALTH PLAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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