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NPI Code Detail

MEDICARE: C. D. DEMARQUE, MD, PA

MEDICARE: C. D. DEMARQUE, MD, PA
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
1261Q00000XClinic/CenterJ1969TX

General Provider Information

NPI Number : 1477963072
Entity Type Code : Organization
Provider Name (Legal Business Name) : C. D. DEMARQUE, MD, PA
Provider Business Mailing Address
First Line : 4020 N MACARTHUR BLVD
Second Line : #122-286
City : IRVING
State : TX
Zip : 75038-6419
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 320 REGAL ROW
Second Line : SUITE 300
City : DALLAS
State : TX
Zip : 75247-5200
Country : US
Telephone Number : 817-308-8477
Fax Number :
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : CHARLES DEMARQUE
Credential :
Telephone Number : 817-308-8477
Provider Enumeration Date : 05/05/2014
Last Update Date : 05/05/2014

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