Provider Demographics
NPI:1053564070
Name:PERSOFF, MYRON MAYER (MD)
Entity type:Individual
Prefix:DR
First Name:MYRON
Middle Name:MAYER
Last Name:PERSOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MYRON
Other - Middle Name:MAYER
Other - Last Name:PERSOFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3659 S MIAMI AVE
Mailing Address - Street 2:SUITE 4006
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4227
Mailing Address - Country:US
Mailing Address - Phone:305-858-5255
Mailing Address - Fax:305-858-5235
Practice Address - Street 1:3659 S MIAMI AVE
Practice Address - Street 2:SUITE 4006
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4227
Practice Address - Country:US
Practice Address - Phone:305-858-5255
Practice Address - Fax:305-858-5235
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME14097208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery