MEDICARE: DR. MARLON D. PADILLA M.D.

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	207P00000X	Emergency Medicine Physician	K2254	TX
2	207PE0005X	Undersea and Hyperbaric Medicine (Emergency Medicine) Physician	K2254	TX
3	207Q00000X	Family Medicine Physician	K2254	TX

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	:	1649263518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARLON D. PADILLA M.D.

Provider Business Mailing Address
First Line	:	8611 HILLCREST AVE STE 180
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-4214
Country	:	US
Telephone Number	:	214-368-3800
Fax Number	:	214-360-7724

Provider Business Practice Location Address
First Line	:	8611 HILLCREST AVE
Second Line	:	SUITE 180
City	:	DALLAS
State	:	TX
Zip	:	75225-4207
Country	:	US
Telephone Number	:	214-368-3800
Fax Number	:

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	02/17/2022

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