Provider Demographics
NPI:1033196068
Name:PEREZ, REYNALDO PEDROLA (MD)
Entity Type:Individual
Prefix:DR
First Name:REYNALDO
Middle Name:PEDROLA
Last Name: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 650426
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0426
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:
Practice Address - Street 1:13737 NOEL ROAD
Practice Address - Street 2:STE 1400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-2004
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1192207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127766708Medicaid
TX050064799OtherRAILROAD
TX127766706Medicaid
TX127766702Medicaid
TX127766707Medicaid
TX84703KOtherBCBS
TX127766703Medicaid
TX127766709OtherMEDICAID CSHCN
TX84703KMedicare PIN
TX84703KOtherBCBS
TXTXB101797Medicare PIN
TX127766709OtherMEDICAID CSHCN
TX127766708Medicaid
C20395Medicare UPIN