Healthcare Provider Details

I. General information

NPI: 1871427799
Provider Name (Legal Business Name): JESUS R PEREZ JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3261 W STATE RD
SAINT BONAVENTURE NY
14778-9800
US

IV. Provider business mailing address

3094 CALLE CARR
EAGLE PASS TX
78852-5750
US

V. Phone/Fax

Practice location:
  • Phone: 716-375-7890
  • Fax:
Mailing address:
  • Phone: 830-968-5309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: