Healthcare Provider Details

I. General information

NPI: 1770610636
Provider Name (Legal Business Name): SOUTHERN ORTHOPAEDICS & SPORTS MEDICINE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5009 S MCCOLL ROAD
EDINBURG TX
78539
US

IV. Provider business mailing address

5009 S MCCOLL ROAD
EDINBURG TX
78539
US

V. Phone/Fax

Practice location:
  • Phone: 956-213-8881
  • Fax: 956-213-8886
Mailing address:
  • Phone: 956-213-8881
  • Fax: 956-213-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberF8611
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberF8611
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberF8611
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberF8611
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberF8611
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberF8611
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberF8611
License Number StateTX
# 8
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberF8611
License Number StateTX

VIII. Authorized Official

Name: DR. FRED LAUREL PEREZ JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 956-213-8881