Healthcare Provider Details

I. General information

NPI: 1699062018
Provider Name (Legal Business Name): MARCELO ERNESTO BRITO TELLES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 12/22/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 TEASLEY LN
DENTON TX
76205-7282
US

IV. Provider business mailing address

2812 DORSET
THE COLONY TX
75056-3592
US

V. Phone/Fax

Practice location:
  • Phone: 940-566-5010
  • Fax:
Mailing address:
  • Phone: 779-770-7011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberQ1103
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberQ1103
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: