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Individual

ALISSA J PEREZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.C

Contact information

Practice address
1600 11TH ST, WICHITA FALLS, TX 76301-4300
(940) 764-7000
Mailing address
1600 11TH ST, WICHITA FALLS, TX 76301
(940) 764-7000

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
001309
IA
363AM0700X
Medical Physician Assistant
Primary
PA05746
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
25402
BLUE SHIELD
IA
01
52057B005
TRICARE
01
IA0109
JOHN DEERE HEALTHCARE
Enumeration date
01/25/2007
Last updated
11/01/2016
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