Provider Demographics
NPI:1285730499
Name:FLOREZ, MARCO TULIO (MD)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:TULIO
Last Name:FLOREZ
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:PO BOX 702
Mailing Address - Street 2:306 WEST PARK
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1613
Mailing Address - Country:US
Mailing Address - Phone:956-781-2953
Mailing Address - Fax:956-781-1733
Practice Address - Street 1:306 WEST PARK
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577
Practice Address - Country:US
Practice Address - Phone:956-781-2953
Practice Address - Fax:956-781-1733
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1010207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112086701Medicaid
TX112086701Medicaid
TXOOEK17Medicare ID - Type UnspecifiedMEDICARE PROVIDER #