Provider Demographics
NPI:1114005188
Name:PEREZ, RICARDO (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 MORGAN AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-1995
Mailing Address - Country:US
Mailing Address - Phone:361-653-0610
Mailing Address - Fax:361-653-0613
Practice Address - Street 1:2222 MORGAN AVE STE 107
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-1995
Practice Address - Country:US
Practice Address - Phone:361-653-0610
Practice Address - Fax:361-653-0613
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2093213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179073501Medicaid
U95593Medicare UPIN
TX179073501Medicaid