Provider Demographics
NPI:1619026226
Name:PEREZ, RICHARD ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ROBERT
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7424 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-3254
Mailing Address - Country:US
Mailing Address - Phone:210-829-8770
Mailing Address - Fax:210-826-4864
Practice Address - Street 1:9502 HUEBNER RD STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1683
Practice Address - Country:US
Practice Address - Phone:210-899-1026
Practice Address - Fax:102-467-9220
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1350213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX742717646OtherTID NUMBER
TX742717646OtherTID NUMBER
TXP084W4022Medicaid
TX1093150001Medicare NSC