Provider Demographics
NPI:1568691780
Name:PEREZ, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6404 NURSERY DR STE 201
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1688
Mailing Address - Country:US
Mailing Address - Phone:361-345-4566
Mailing Address - Fax:888-849-3841
Practice Address - Street 1:6404 NURSERY DR STE 201
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1688
Practice Address - Country:US
Practice Address - Phone:361-345-4566
Practice Address - Fax:888-849-3841
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9003207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX362396901Medicaid