Provider Demographics
NPI:1841222890
Name:PEREZ, MARIO (DO)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 LAKEVIEW DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-3552
Mailing Address - Country:US
Mailing Address - Phone:361-790-5155
Mailing Address - Fax:361-790-5156
Practice Address - Street 1:2600 LAKEVIEW DR
Practice Address - Street 2:SUITE D
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-3552
Practice Address - Country:US
Practice Address - Phone:361-790-5155
Practice Address - Fax:361-790-5156
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK4526207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8EZ458OtherBCBS
TX8EZ458OtherBCBS
TX334027ZNC8Medicare PIN