Provider Demographics
NPI:1003977323
Name:FLOREZ-PEREZ, JULIAN ALBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:ALBERTO
Last Name:FLOREZ-PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3238
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0055
Mailing Address - Country:US
Mailing Address - Phone:956-580-8072
Mailing Address - Fax:956-583-3050
Practice Address - Street 1:1810 E GRIFFIN PKWY
Practice Address - Street 2:SUITE A-4
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-8518
Practice Address - Country:US
Practice Address - Phone:956-580-8072
Practice Address - Fax:956-583-3050
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042086207Q00000X
TXN5677207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8357428Medicaid
TX8CR708OtherBCBS
WA8938967OtherDEPT L&I CV #
WA0172398OtherWA STATE DEPT L&I #
WA8357428Medicaid
WA8938967OtherDEPT L&I CV #
TXTXB119896Medicare PIN
WAAB38472Medicare ID - Type UnspecifiedMEDICARE PROVIDER #