Basic Information
| Provider Information | |||||||||
| NPI: | 1003806332 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARQUINO | ||||||||
| FirstName: | REY | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | M0810 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 179037001 | 05 | TX | MEDICAID | 179037005 | 05 | TX | MEDICAID | 2161897 | 05 | OH | MEDICAID | 179037003 | 05 | TX | MEDICAID | 179037002 | 05 | TX | MEDICAID | 179037004 | 05 | TX | MEDICAID |