Provider Demographics
NPI:1578963450
Name:PEREZ, JOSE MANUEL II (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:MANUEL
Last Name:PEREZ
Suffix:II
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:717 HIGHWAY 71 W STE 500
Mailing Address - Street 2:500
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-4148
Mailing Address - Country:US
Mailing Address - Phone:512-332-2273
Mailing Address - Fax:
Practice Address - Street 1:717 HIGHWAY 71 W STE 500
Practice Address - Street 2:500
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-4148
Practice Address - Country:US
Practice Address - Phone:512-332-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant