Provider Demographics
NPI:1265656839
Name:LAREDO FAMILY MEDICINE P A
Entity Type:Organization
Organization Name:LAREDO FAMILY MEDICINE P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-728-9888
Mailing Address - Street 1:4151 JAIME ZAPATA MEMORIAL HIGHWAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-4741
Mailing Address - Country:US
Mailing Address - Phone:956-728-9888
Mailing Address - Fax:956-728-9879
Practice Address - Street 1:4151 JAIME ZAPATA MEMORIAL HIGHWAY
Practice Address - Street 2:SUITE 104
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-4741
Practice Address - Country:US
Practice Address - Phone:956-728-9888
Practice Address - Fax:956-728-9879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00X861Medicare PIN