Provider Demographics
NPI:1275672560
Name:PREZAS FAMILY MEDICINE, P.A.
Entity Type:Organization
Organization Name:PREZAS FAMILY MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:PREZAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:979-297-7555
Mailing Address - Street 1:120 FLAG LAKE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-6201
Mailing Address - Country:US
Mailing Address - Phone:979-297-7555
Mailing Address - Fax:979-297-7552
Practice Address - Street 1:120 FLAG LAKE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-6201
Practice Address - Country:US
Practice Address - Phone:979-297-7555
Practice Address - Fax:979-297-7552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4656207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM80589073Medicaid
TXH97700Medicare UPIN
TX00X300Medicare PIN