MEDICARE: RAFAEL JOSE PEREZ M.D.

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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	K6225	TX
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	K6225	TX
3	207RP1001X	Pulmonary Disease Physician	K6225	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8AK461	OTHER	TX	BCBS INDIVIDUAL #

General Provider Information

NPI Number	:	1194706432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAFAEL JOSE PEREZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:	254-724-8800
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 HILLCREST MEDICAL BLVD
Second Line	:	SUITE 212
City	:	WACO
State	:	TX
Zip	:	76712-8897
Country	:	US
Telephone Number	:	254-202-5800
Fax Number	:	254-202-5849

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

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	01/06/2021

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