Provider Demographics
NPI:1316939200
Name:CALDERON, MARCOS (MD)
Entity type:Individual
Prefix:MR
First Name:MARCOS
Middle Name:
Last Name:CALDERON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1717 N BROWN ST
Mailing Address - Street 2:BLDG 3
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4727
Mailing Address - Country:US
Mailing Address - Phone:915-544-0526
Mailing Address - Fax:915-544-2877
Practice Address - Street 1:1717 N BROWN ST
Practice Address - Street 2:BLDG 3
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4727
Practice Address - Country:US
Practice Address - Phone:915-544-0526
Practice Address - Fax:915-544-2877
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE2159207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC14073Medicare UPIN
00K89DMedicare ID - Type Unspecified