Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | M8247 | TX |
NPI | 1053598771 |
---|---|
Provider Name | Dr. Gabriel Perez |
First Address | San Antonio, TX 78221-3117 |
Second Address | San Antonio, TX 78251-3750 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2008 |
Last Update Date | 24/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
192520801 | (05) | TX |
192520803 | (05) | TX |