Provider Demographics
NPI:1598783870
Name:PEREZ, CARLOS LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:LUIS
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:921 TEXAS BLVD
Mailing Address - Street 2:STE D
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-5163
Mailing Address - Country:US
Mailing Address - Phone:903-792-3660
Mailing Address - Fax:903-793-3187
Practice Address - Street 1:921 TEXAS BLVD
Practice Address - Street 2:STE D
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5163
Practice Address - Country:US
Practice Address - Phone:903-792-3660
Practice Address - Fax:903-793-3187
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-04-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK9147207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200092740AOtherOK CAID
TX8A801OtherTX BCBS
AR98310OtherAR BCBS
TX140912001Medicaid
TX140912001Medicaid
AR98310OtherAR BCBS