Provider Demographics
NPI:1477541662
Name:PEREZ, ANGEL JR (MD)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:PEREZ
Suffix:JR
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 1:15055 EAST FREEWAY
Mailing Address - Street 2:B60
Mailing Address - City:CHANNELVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:77530-4192
Mailing Address - Country:US
Mailing Address - Phone:281-452-4444
Mailing Address - Fax:281-452-4494
Practice Address - Street 1:15055 EAST FWY STE B60
Practice Address - Street 2:
Practice Address - City:CHANNELVIEW
Practice Address - State:TX
Practice Address - Zip Code:77530-4192
Practice Address - Country:US
Practice Address - Phone:281-452-4444
Practice Address - Fax:281-452-4494
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1693207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X661Medicare PIN
H38011Medicare UPIN