Provider Demographics
NPI:1437561412
Name:PEREZ, EVAN DUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:DUSTIN
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 531968
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553-1968
Mailing Address - Country:US
Mailing Address - Phone:833-847-4863
Mailing Address - Fax:956-296-6842
Practice Address - Street 1:3804 S JACKSON RD STE 1
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-6681
Practice Address - Country:US
Practice Address - Phone:956-296-3001
Practice Address - Fax:956-296-3000
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR0100207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3912560-01Medicaid
TXH08JU12901OtherBCBS