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General NPI Number Information
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NPI Number | 1114276276
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Entity Type | Organization
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Legal Business Name | MARIE D PERCY MD PA
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Dates
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Enumeration Date | 09/05/2012
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Last Update Date | 02/28/2014
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Provider Practice Location Address
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Address Line | 4210 50TH ST SUITE D
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City | LUBBOCK
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State | TX
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Zip | 79413-3863
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Country | US
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Telephone | 806-795-1431
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Fax | 806-795-1461
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Provider Business Mailing Address
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Address Line | 4210 50TH ST SUITE D
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City | LUBBOCK
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State | TX
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Zip | 79413-3863
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Country | US
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Telephone | 806-795-1431
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Fax | 806-795-1461
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | BRANDI TADLOCK
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Credential |
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Telephone | 806-795-1431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L4197
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License Number State | TX
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