Provider Demographics
NPI:1750564480
Name:COLE-PEREZ, MARY CATHLEEN (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CATHLEEN
Last Name:COLE-PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CATHLEEN
Other - Last Name:COLE-PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
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:78414-4103
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
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2311207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K8442Medicare PIN
TXE71021Medicare UPIN