Provider Demographics
NPI:1679562706
Name:JOSE L. PEREZ-BECERRA, M.D., P.A.
Entity type:Organization
Organization Name:JOSE L. PEREZ-BECERRA, M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEREZ-BECERRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-924-5121
Mailing Address - Street 1:1327 SW MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1538
Mailing Address - Country:US
Mailing Address - Phone:210-924-5121
Mailing Address - Fax:210-923-5656
Practice Address - Street 1:1327 SW MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1538
Practice Address - Country:US
Practice Address - Phone:210-924-5121
Practice Address - Fax:210-923-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085712001Medicaid
TX085712001Medicaid