Provider Demographics
NPI:1831281625
Name:MARY CATHLEEN COLE-PEREZ MD PA
Entity Type:Organization
Organization Name:MARY CATHLEEN COLE-PEREZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CATHLEEN
Authorized Official - Last Name:COLE-PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-993-7546
Mailing Address - Street 1:5920 SARATOGA BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414
Mailing Address - Country:US
Mailing Address - Phone:361-993-7546
Mailing Address - Fax:361-993-6617
Practice Address - Street 1:5920 SARATOGA BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4103
Practice Address - Country:US
Practice Address - Phone:361-993-7546
Practice Address - Fax:361-993-6617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2311207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE71021Medicare UPIN
TX00H60CMedicare PIN