Provider Demographics
NPI:1922690882
Name:PEREZ, MAUD ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:MAUD
Middle Name:ELIZABETH
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAUD
Other - Middle Name:ELIZABETH
Other - Last Name:DELGADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3307 BLUE CATFISH DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-2178
Mailing Address - Country:US
Mailing Address - Phone:305-833-3319
Mailing Address - Fax:
Practice Address - Street 1:1918 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-3202
Practice Address - Country:US
Practice Address - Phone:904-389-6954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2024-12-10
Deactivation Date:2021-10-05
Deactivation Code:
Reactivation Date:2023-06-12
Provider Licenses
StateLicense IDTaxonomies
PR24096208D00000X
FLACN1682208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice