Provider Demographics
NPI:1699708990
Name:CRESCENT FAMILY MEDICINE
Entity type:Organization
Organization Name:CRESCENT FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:V
Authorized Official - Last Name:MARZOCCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-747-0777
Mailing Address - Street 1:820 S ALMA DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3808
Mailing Address - Country:US
Mailing Address - Phone:972-747-0777
Mailing Address - Fax:214-383-4559
Practice Address - Street 1:820 S ALMA DR
Practice Address - Street 2:SUITE 130
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3808
Practice Address - Country:US
Practice Address - Phone:972-747-0777
Practice Address - Fax:214-383-4559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1677207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5NPOtherBLUE CROSS BLUE SHIELD
00W656Medicare PIN
TXI41261Medicare UPIN