Provider Demographics
NPI:1710174024
Name:PEREZ, IGNACIO WILLIAM
Entity Type:Individual
Prefix:
First Name:IGNACIO
Middle Name:WILLIAM
Last Name:PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:FAIRFIELD
Other - Middle Name:AMBULANCE
Other - Last Name:SERVICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:740 W COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:75840-1428
Mailing Address - Country:US
Mailing Address - Phone:903-389-6511
Mailing Address - Fax:903-389-9731
Practice Address - Street 1:740 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:TX
Practice Address - Zip Code:75840-1428
Practice Address - Country:US
Practice Address - Phone:903-389-6511
Practice Address - Fax:903-389-9731
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX081006146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000126501Medicaid
TX506682Medicare PIN