MEDICARE: DR. ENRIQUE RAFAEL PEREZ-RODRIGUEZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	K2172	TX

General Provider Information

NPI Number	:	1174571434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ENRIQUE RAFAEL PEREZ-RODRIGUEZ MD

Provider Business Mailing Address
First Line	:	4950 SAN PEDRO AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-1442
Country	:	US
Telephone Number	:	210-828-9700
Fax Number	:	210-822-8222

Provider Business Practice Location Address
First Line	:	4950 SAN PEDRO AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-1442
Country	:	US
Telephone Number	:	210-828-9700
Fax Number	:	210-822-8222

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	07/08/2007

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