MEDICARE: MARCO ELIZONDO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	L1840	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1L5458	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386679058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCO ELIZONDO MD

Provider Business Mailing Address
First Line	:	919 HIDDEN RDG
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-3813
Country	:	US
Telephone Number	:	469-282-2711
Fax Number	:	469-282-0996

Provider Business Practice Location Address
First Line	:	1038 TEXAS YES BLVD
Second Line	:
City	:	ROBSTOWN
State	:	TX
Zip	:	78380-6142
Country	:	US
Telephone Number	:	361-767-1200
Fax Number	:	361-387-5184

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	04/30/2021

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Directions to “ MARCO ELIZONDO MD” Practice Location

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