Provider Demographics
NPI:1508069790
Name:PERO, ROXANNE E (MD)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:E
Last Name:PERO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:8160 WALNUT HILL LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4339
Mailing Address - Country:US
Mailing Address - Phone:214-363-4421
Mailing Address - Fax:214-987-1657
Practice Address - Street 1:8160 WALNUT HILL LN
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4339
Practice Address - Country:US
Practice Address - Phone:214-363-4421
Practice Address - Fax:214-987-1657
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
TXN5332207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN5332OtherTEXAS MEDICAL BOARD
BP1-0026451OtherINSTITUTIONAL PERMIT