Healthcare Provider Details

I. General information

NPI: 1811286420
Provider Name (Legal Business Name): CLAUDIA ANDIRA PEREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 5TH AVE STE 500
FORT WORTH TX
76104-7304
US

IV. Provider business mailing address

800 5TH AVE STE 500
FORT WORTH TX
76104-7304
US

V. Phone/Fax

Practice location:
  • Phone: 817-250-4285
  • Fax: 817-250-4281
Mailing address:
  • Phone: 817-250-4285
  • Fax: 817-250-4281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberQ5065
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberQ5065
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberQ5065
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: