Provider Demographics
NPI:1548242274
Name:PEREZ, RODOLFO NESTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:NESTOR
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 1:1519 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6605
Mailing Address - Country:US
Mailing Address - Phone:956-968-3171
Mailing Address - Fax:956-968-5783
Practice Address - Street 1:1519 E 6TH ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6605
Practice Address - Country:US
Practice Address - Phone:956-968-3171
Practice Address - Fax:956-968-5783
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0616174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC20399Medicare UPIN
TX807118Medicare PIN