Provider Demographics
NPI:1285697615
Name:PEREZ, RAOUL (MD)
Entity type:Individual
Prefix:
First Name:RAOUL
Middle Name:
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 1:108 S. WILLIAM BARNETT AVE.
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327
Mailing Address - Country:US
Mailing Address - Phone:281-592-9775
Mailing Address - Fax:281-592-1570
Practice Address - Street 1:309 HWY 59 SOUTH LOOP
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351
Practice Address - Country:US
Practice Address - Phone:936-327-1055
Practice Address - Fax:936-327-5656
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5897207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122987405Medicaid
TX8L72222Medicare PIN