MEDICARE: ROY R MARRERO JR. 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	207P00000X	Emergency Medicine Physician	J9750	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8R9683	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1841249414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROY R MARRERO JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 8730
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76124-0730
Country	:	US
Telephone Number	:	817-451-4208
Fax Number	:

Provider Business Practice Location Address
First Line	:	2555 JIMMY JOHNSON BLVD
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77640-2007
Country	:	US
Telephone Number	:	409-724-7389
Fax Number	:

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

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	07/08/2007

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