Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | M0810 | TX |
Y | 111NI0900X | Internist | M0810 | TX |
NPI | 1003806332 |
---|---|
Provider Name | Rey C Marquino |
First Address | Bedford, TX 76022-5935 |
Second Address | Bedford, TX 76022-5935 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 04/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
179037001 | (05) | TX |
179037002 | (05) | TX |
179037003 | (05) | TX |
179037004 | (05) | TX |
179037005 | (05) | TX |
2161897 | (05) | OH |
H13472 | (02) | TX |