1366557548 NPI number — RAUL A. MARQUEZ, MD PA

Table of content: (NPI 1366557548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366557548 NPI number — RAUL A. MARQUEZ, MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAUL A. MARQUEZ, MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ORTHOPEDICS SURGERY CENTER AND SPORTS MEDICINE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366557548
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2402 CORNERSTONE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDINBURG
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78539-8462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-680-0060
Provider Business Mailing Address Fax Number:
956-668-0070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2402 CORNERSTONE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINBURG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78539-8462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-668-0060
Provider Business Practice Location Address Fax Number:
956-668-0070
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARQUEZ
Authorized Official First Name:
RAUL
Authorized Official Middle Name:
ALFONSO
Authorized Official Title or Position:
ORTHOPEDIC SURGEON
Authorized Official Telephone Number:
956-668-0060

Provider Taxonomy Codes

  • Taxonomy code: 207XS0114X , with the licence number:  J1302 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 084243701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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