Provider Demographics
NPI:1588977292
Name:JOAQUIN MARRON M D P A
Entity type:Organization
Organization Name:JOAQUIN MARRON M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOAQUIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:210-434-0551
Mailing Address - Street 1:718 CUPPLES RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78237-4357
Mailing Address - Country:US
Mailing Address - Phone:210-434-0551
Mailing Address - Fax:210-434-3030
Practice Address - Street 1:718 CUPPLES RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237-4357
Practice Address - Country:US
Practice Address - Phone:210-434-0551
Practice Address - Fax:210-434-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDO211146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0921082-01Medicaid
TX009742Medicare PIN