Provider Demographics
NPI:1235112285
Name:PEREZ, ABIMAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ABIMAEL
Middle Name:
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 1:2922 MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405
Mailing Address - Country:US
Mailing Address - Phone:361-887-6601
Mailing Address - Fax:361-887-8225
Practice Address - Street 1:2922 MORGAN AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405
Practice Address - Country:US
Practice Address - Phone:361-887-6601
Practice Address - Fax:361-887-8225
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00H36NOtherMEDICARE
TX098618403Medicaid
TX302714YLPSOtherWELLMED PTAN
TX0829053 01Medicaid
TX098618403Medicaid