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General NPI Number Information
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NPI Number | 1376501635
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Entity Type | Individual
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Provider Name | MAURICE G SYRQUIN MD
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Gender | Male
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 3414 OAK GROVE AVE
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City | DALLAS
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State | TX
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Zip | 75204-2375
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Country | US
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Telephone | 214-521-1153
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Fax | 214-219-3651
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Provider Business Mailing Address
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Address Line | 3414 OAK GROVE AVE
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City | DALLAS
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State | TX
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Zip | 75204-2375
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Country | US
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Telephone | 214-521-1153
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Fax | 214-219-3651
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | H9162
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | G69442
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G69442
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 73015
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License Number State | MA
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Taxonomy #5
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | H9162
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | 73015
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License Number State | MA
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