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General NPI Number Information
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NPI Number | 1457532442
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Entity Type | Organization
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Legal Business Name | ST. MATTHEW DERMATOLOGY CLINIC, P.A.
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Dates
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Enumeration Date | 11/18/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 808 TOWER DR STE 3
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City | ODESSA
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State | TX
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Zip | 79761-4256
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Country | US
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Telephone | 432-582-0370
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Fax |
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Provider Business Mailing Address
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Address Line | 808 TOWER DR STE 3
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City | ODESSA
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State | TX
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Zip | 79761-4256
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Country | US
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Telephone | 432-582-0370
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RENATO MARQUEZ ORACION
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Credential | M.D.
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Telephone | 432-582-0370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | L4085
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License Number State | TX
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