Provider Demographics
NPI:1649278276
Name:PEREZ, JUAN RODRIGO (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:RODRIGO
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 E REDD RD
Mailing Address - Street 2:BLDG. 2
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7221
Mailing Address - Country:US
Mailing Address - Phone:915-845-2220
Mailing Address - Fax:915-845-2221
Practice Address - Street 1:840 E REDD RD
Practice Address - Street 2:BLDG. 2
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7221
Practice Address - Country:US
Practice Address - Phone:915-845-2220
Practice Address - Fax:915-845-2221
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1683351-01Medicaid
TX8P9370OtherBCBS
TX201389499OtherTAX ID
TX8P9370OtherBCBS
TX1683351-01Medicaid
TX00527XMedicare ID - Type UnspecifiedGROUP