| Jorge L Perez Polanco Md Inc | |
|
119 Oakfield Dr Brandon FL 33511-5779 | |
| (239) 677-0323 | |
| (813) 600-3416 |
| Full Name | Jorge L Perez Polanco Md Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 119 Oakfield Dr, Brandon, Florida |
| Authorized Official Name and Position | Jorge L Perez (OWNER) |
| Authorized Official Contact | 2396770323 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jorge L Perez Polanco Md Inc Po Box 495009 Port Charlotte FL 33949-5009 Ph: (239) 677-0323 | Jorge L Perez Polanco Md Inc 119 Oakfield Dr Brandon FL 33511-5779 Ph: (239) 677-0323 |
| NPI Number | 1891058707 |
|---|---|
| Provider Enumeration Date | 06/18/2012 |
| Last Update Date | 06/18/2012 |
| Medicare PECOS PAC ID | 6406004050 |
|---|---|
| Medicare Enrollment ID | O20120924000678 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891058707 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME94246 (Florida) | Primary |
| Provider Name | Jorge L Perez Polanco |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538158761 PECOS PAC ID: 1759301815 Enrollment ID: I20051205000043 |
| Provider Name | Wendy M Damato |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285065060 PECOS PAC ID: 7012236565 Enrollment ID: I20150505000509 |
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