Provider Demographics
NPI:1174571434
Name:PEREZ-RODRIGUEZ, ENRIQUE RAFAEL (MD)
Entity type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:RAFAEL
Last Name:PEREZ-RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ENRIQUE
Other - Middle Name:RAFAEL
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4950 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-1442
Mailing Address - Country:US
Mailing Address - Phone:210-828-9700
Mailing Address - Fax:210-822-8222
Practice Address - Street 1:4950 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-1442
Practice Address - Country:US
Practice Address - Phone:210-828-9700
Practice Address - Fax:210-822-8222
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2172207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG42026Medicare UPIN
TX00898PMedicare ID - Type Unspecified