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NPI Code Detail

MEDICARE: MR. RON J PERAZA FNP-C

MEDICARE:  MR. RON J PERAZA  FNP-C
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
1363LF0000XFamily Nurse Practitioner641417TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P01220701OTHERTXRAILROAD MCARE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386918225
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RON J PERAZA FNP-C
Provider Business Mailing Address
First Line : PO BOX 815
Second Line :
City : MIDLAND
State : TX
Zip : 79702-0815
Country : US
Telephone Number : 432-889-7484
Fax Number :
Provider Business Practice Location Address
First Line : 5106 BLUE HAVEN DR
Second Line :
City : MIDLAND
State : TX
Zip : 79703-6301
Country : US
Telephone Number : 432-889-7484
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2012
Last Update Date : 05/16/2017

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