Basic Information
Provider Information
NPI: 1003806332
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARQUINO
FirstName: REY
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1615 HOSPITAL PKWY STE 103
Address2:  
City: BEDFORD
State: TX
PostalCode: 760225935
CountryCode: US
TelephoneNumber: 8173542680
FaxNumber: 8175105927
Practice Location
Address1: 1615 HOSPITAL PKWY STE 103
Address2:  
City: BEDFORD
State: TX
PostalCode: 760225935
CountryCode: US
TelephoneNumber: 8173542680
FaxNumber: 8175105927
Other Information
ProviderEnumerationDate: 10/27/2005
LastUpdateDate: 09/04/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XM0810TXY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
17903700405TX MEDICAID
17903700205TX MEDICAID
216189705OH MEDICAID
17903700505TX MEDICAID
17903700105TX MEDICAID
17903700305TX MEDICAID


Home