Basic Information
| Provider Information | |||||||||
| NPI: | 1437561412 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEREZ | ||||||||
| FirstName: | EVAN | ||||||||
| MiddleName: | DUSTIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 E DOVE AVE | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785043974 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563623520 | ||||||||
| FaxNumber: | 9563623529 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 E DOVE AVE | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563623520 | ||||||||
| FaxNumber: | 9563623529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2014 | ||||||||
| LastUpdateDate: | 04/01/2019 | ||||||||
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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 | 207QS0010X | R0100 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3912560-01 | 05 | TX | MEDICAID | H08JU12901 | 01 | TX | BCBS | OTHER |