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General NPI Number Information
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NPI Number | 1396975652
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Entity Type | Individual
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Provider Name | ISSAM MARZOUK M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/21/2009
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4305 N MESA ST SUITE A
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City | EL PASO
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State | TX
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Zip | 79902-1123
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Country | US
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Telephone | 915-532-2477
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Fax | 915-532-2470
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Provider Business Mailing Address
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Address Line | 4305 N MESA ST STE A
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City | EL PASO
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State | TX
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Zip | 79902-1124
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Country | US
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Telephone | 915-532-2477
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Fax | 915-532-2470
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | Q6345
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | RS2014-0452
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | Q6345
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License Number State | TX
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