Provider Demographics
NPI:1386848968
Name:PEREZ, ALFONSO ENRIQUEZ (DO)
Entity Type:Individual
Prefix:
First Name:ALFONSO
Middle Name:ENRIQUEZ
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7585 KITTY HAWK STE 201
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-2820
Mailing Address - Country:US
Mailing Address - Phone:104-682-3332
Mailing Address - Fax:210-667-4044
Practice Address - Street 1:7330 SAN PEDRO AVE STE 540
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6250
Practice Address - Country:US
Practice Address - Phone:210-344-7287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0361207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K9017Medicare PIN