Provider Demographics
NPI:1194774380
Name:VERGNE-MARINI, PEDRO (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:VERGNE-MARINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 VICEROY DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-2208
Mailing Address - Country:US
Mailing Address - Phone:214-358-2300
Mailing Address - Fax:214-366-6127
Practice Address - Street 1:1150 N BISHOP AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4168
Practice Address - Country:US
Practice Address - Phone:214-358-2300
Practice Address - Fax:214-366-6461
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1436207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX862034OtherBCBS #
TX2227295OtherBLUELINK #
TX4077339OtherAETNA #
TX2227295OtherBLUELINK #
TXB27295Medicare UPIN