1174609564 NPI number — GUILLERMO R PEREZ MD

Table of content: GUILLERMO R PEREZ MD (NPI 1174609564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174609564 NPI number — GUILLERMO R PEREZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEREZ
Provider First Name:
GUILLERMO
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174609564
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78502-5550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-627-3686
Provider Business Mailing Address Fax Number:
956-664-0531

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5015 S MCCOLL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINBURG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78539-8080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-627-3686
Provider Business Practice Location Address Fax Number:
956-664-0531
Provider Enumeration Date:
10/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  L7519 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2086S0127X , with the licence number: L7519 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 163901503 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 163901502 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8AJ752 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TXB109453 . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00221107 . This is a "RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00911268 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 163901505 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 163901504 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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