Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 2093 | TX |
NPI | 1114005188 |
---|---|
Provider Name | Dr. Ricardo Perez |
First Address | Corpus Christi, TX 78405-1995 |
Second Address | Corpus Christi, TX 78405-1995 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 13/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
179073501 | (05) | TX |
U95593 | (02) |