Provider Demographics
NPI:1174609564
Name:PEREZ, GUILLERMO R (MD)
Entity type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:R
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:PO BOX 5550
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-5550
Mailing Address - Country:US
Mailing Address - Phone:956-627-3686
Mailing Address - Fax:956-664-0531
Practice Address - Street 1:5015 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8080
Practice Address - Country:US
Practice Address - Phone:956-627-3686
Practice Address - Fax:956-664-0531
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7519208600000X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163901503Medicaid
TX163901502Medicaid
TX8AJ752OtherBCBS
TXTXB109453OtherMEDICARE
TXP00221107OtherRAILROAD
TXP00911268OtherRAILROAD MEDICARE
TX163901505Medicaid
TX163901504Medicaid
TX163901503Medicaid
TX8D1844Medicare PIN
TX8J1431Medicare PIN
TX163901504Medicaid