Provider Demographics
NPI:1265456438
Name:PEREZ, ROGELIO (MD)
Entity type:Individual
Prefix:
First Name:ROGELIO
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3001 EXECUTIVE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-5323
Mailing Address - Country:US
Mailing Address - Phone:727-347-0005
Mailing Address - Fax:275-416-5587
Practice Address - Street 1:6225 66TH ST N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-5025
Practice Address - Country:US
Practice Address - Phone:727-521-0994
Practice Address - Fax:727-522-2671
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2024-12-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME152674207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2V7006OtherHEALTH NET
FL6BECDOtherFL BLUE
CT1087651OtherAETNA
FL112579800Medicaid
CT043514OtherCONNECTICARE
CT010043514CT01OtherBLUE CROSS BLUE SHIELD