Provider Demographics
NPI:1447229547
Name:PEREZ, JOSE A (P A)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:A
Last Name:PEREZ
Suffix:
Gender:M
Credentials:P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10223 BROADWAY ST
Mailing Address - Street 2:P317
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7880
Mailing Address - Country:US
Mailing Address - Phone:281-746-4949
Mailing Address - Fax:
Practice Address - Street 1:7807 MCPHERSON AVE
Practice Address - Street 2:STE 2E
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-2801
Practice Address - Country:US
Practice Address - Phone:956-726-0501
Practice Address - Fax:956-726-6361
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00131363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical