Provider Demographics
NPI:1679692743
Name:ABIMAEL PEREZ, MD, PA
Entity Type:Organization
Organization Name:ABIMAEL PEREZ, MD, PA
Other - Org Name:ABIMAEL PEREZ
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ABIMAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-887-6601
Mailing Address - Street 1:2922 MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-2141
Mailing Address - Country:US
Mailing Address - Phone:361-887-6601
Mailing Address - Fax:361-887-8225
Practice Address - Street 1:2922 MORGAN AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-2141
Practice Address - Country:US
Practice Address - Phone:361-887-6601
Practice Address - Fax:361-887-8225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0829053 01Medicaid
TXC 20394Medicare UPIN