Healthcare Provider Details

I. General information

NPI: 1821482886
Provider Name (Legal Business Name): MARCIAL ANDRES OQUENDO RINCON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18220 MIDWAY RD
DALLAS TX
75287-4901
US

IV. Provider business mailing address

18220 MIDWAY RD
DALLAS TX
75287-4901
US

V. Phone/Fax

Practice location:
  • Phone: 469-501-1006
  • Fax: 972-913-4303
Mailing address:
  • Phone: 469-501-1006
  • Fax: 972-913-4303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberQ8590
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberQ8590
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: