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NPI Code Detail

MEDICARE: DWAYNE D MARROTT PHD

MEDICARE: DWAYNE D MARROTT PHD
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
1103TC0700XClinical Psychologist24316TX

Other Identifiers

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

General Provider Information

NPI Number : 1730290065
Entity Type Code : Individual
Provider Name (Legal Business Name) : DWAYNE D MARROTT PHD
Provider Business Mailing Address
First Line : 913 VIA CORTA CT
Second Line :
City : EL PASO
State : TX
Zip : 79912-6643
Country : US
Telephone Number : 915-833-2520
Fax Number : 915-598-6651
Provider Business Practice Location Address
First Line : 10450 BRIAN MOONEY AVE
Second Line :
City : EL PASO
State : TX
Zip : 79935-2809
Country : US
Telephone Number : 915-598-6616
Fax Number : 915-598-6651
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 05/26/2016

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