Provider Demographics
NPI:1437108081
Name:PEREZ, ENRIQUE A (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:A
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:4325 N JOSEY LN
Practice Address - Street 2:TRINITY MEDICAL PLAZA III, SUITE 200
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4635
Practice Address - Country:US
Practice Address - Phone:972-394-4368
Practice Address - Fax:972-394-4941
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5443207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124523507Medicaid
TX124523513Medicaid
TXP01530295OtherRAILROAD MEDICARE
TX124523508Medicaid
TX124523509Medicaid
TX124523514Medicaid
TXP01530295OtherRAILROAD MEDICARE
TXE67273Medicare UPIN
TX8L11436Medicare PIN
TXTXB150822Medicare PIN
TX124523513Medicaid
TX124523507Medicaid
TX124523514Medicaid