Provider Demographics
NPI:1588891659
Name:MARINES COPADO, DIEGO C (MD)
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:C
Last Name:MARINES COPADO
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 1:18220 TOMBALL PKWY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4347
Mailing Address - Country:US
Mailing Address - Phone:281-737-8465
Mailing Address - Fax:
Practice Address - Street 1:18220 TOMBALL PKWY
Practice Address - Street 2:SUITE 280
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4347
Practice Address - Country:US
Practice Address - Phone:281-737-8465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10035355390200000X
TXQ4802208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8GD704OtherBCBS
TX8FG094OtherBLUE CROSS BLUE SHIELD
TX350607301Medicaid
TX350607302Medicaid
TX8FG094OtherBLUE CROSS BLUE SHIELD
TX350607302Medicaid