Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | M2565 | TX |
N | 207RX0202X | Medical Oncology | M2565 | TX |
NPI | 1134166788 |
---|---|
Provider Name | Dr. Marcelo Moreira Boek |
First Address | Dallas, TX 75391-1230 |
Second Address | Mcallen, TX 78503-1271 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 07/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8U7564 | BLUE CROSS OF TEXAS (01) | TX |
I50603 | (02) |