Basic Information
| Provider Information | |||||||||
| NPI: | 1437108081 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEREZ | ||||||||
| FirstName: | ENRIQUE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 911230 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753911230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729978000 | ||||||||
| FaxNumber: | 9722342987 | ||||||||
| Practice Location | |||||||||
| Address1: | 4325 N JOSEY LN | ||||||||
| Address2: | TRINITY MEDICAL PLAZA III, SUITE 200 | ||||||||
| City: | CARROLLTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750104635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723944368 | ||||||||
| FaxNumber: | 9723944941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 01/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | J5443 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RX0202X | J5443 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 124523507 | 05 | TX | MEDICAID | 124523513 | 05 | TX | MEDICAID | P01530295 | 01 | TX | RAILROAD MEDICARE | OTHER | 124523508 | 05 | TX | MEDICAID | 124523509 | 05 | TX | MEDICAID | 124523514 | 05 | TX | MEDICAID |