MEDICARE: MRS. TERESA MARQUEZ-SMITH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	J6014	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114998051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERESA MARQUEZ-SMITH MD

Provider Business Mailing Address
First Line	:	11331 JAMES WATT DR
Second Line	:	STE 600
City	:	EL PASO
State	:	TX
Zip	:	79936-6401
Country	:	US
Telephone Number	:	915-838-1400
Fax Number	:

Provider Business Practice Location Address
First Line	:	11331 JAMES WATT DR
Second Line	:	STE 600
City	:	EL PASO
State	:	TX
Zip	:	79936-6401
Country	:	US
Telephone Number	:	915-838-1400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	10/31/2016

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