Provider Demographics
NPI:1962400937
Name:PEREZ, ISAAC (MD)
Entity type:Individual
Prefix:
First Name:ISAAC
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 1:3821 LONG PRAIRIE RD
Mailing Address - Street 2:100
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028
Mailing Address - Country:US
Mailing Address - Phone:972-221-2784
Mailing Address - Fax:972-420-0499
Practice Address - Street 1:3821 LONG PRAIRIE RD
Practice Address - Street 2:100
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028
Practice Address - Country:US
Practice Address - Phone:972-221-2784
Practice Address - Fax:972-420-0499
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2015-11-04
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
TXK3823207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A8283Medicare ID - Type Unspecified
G39224Medicare UPIN