Doctor Name: | RYAN J PEREIRA |
NPI Number: | 1033195979 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DPM |
License Number: | PO3002 |
Business Practice Address: | 1301 Plantation Island Dr S Ste 203 St Augustine, FL - 320803108 |
Business Phone Number: | 9044610821 |
Business Fax Number: | 9044610823 |
Mailing Address: | 1301 Plantation Island Dr S, Ste 203a ST AUGUSTINE |
State: | FL |
Postal Code: | 320803108 |
Phone Number: | 9044610821 |
Fax Number: | 9044610823 |
NPI Enumeration Date: | 12/22/2005 |
NPI Last Update Date: | 06/30/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | PO3002 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |