Provider Demographics
NPI:1386918225
Name:PERAZA, RON J (FNP-C)
Entity type:Individual
Prefix:MR
First Name:RON
Middle Name:J
Last Name:PERAZA
Suffix:
Gender:M
Credentials:FNP-C
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 815
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79702-0815
Mailing Address - Country:US
Mailing Address - Phone:432-889-7484
Mailing Address - Fax:
Practice Address - Street 1:5106 BLUE HAVEN DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-6301
Practice Address - Country:US
Practice Address - Phone:432-889-7484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX641417363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01220701OtherRAILROAD MCARE
TX300987001Medicaid
TX300987001Medicaid