MEDICARE: RENE PEREZ, MD, PA

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	207VX0000X	Obstetrics Physician	M6336	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8AW080	OTHER	TX	BCBS ID

General Provider Information

NPI Number	:	1760668008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENE PEREZ, MD, PA

Provider Business Mailing Address
First Line	:	3903 WISEMAN BLVD
Second Line	:	SUITE 300
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4401
Country	:	US
Telephone Number	:	210-426-3663
Fax Number	:

Provider Business Practice Location Address
First Line	:	3903 WISEMAN BLVD
Second Line	:	SUITE 300
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4401
Country	:	US
Telephone Number	:	210-426-3663
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	DR. RENE PEREZ
Credential	:	MD
Telephone Number	:	210-426-3663

Provider Enumeration Date	:	01/17/2008
Last Update Date	:	08/14/2008

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