MEDICARE: DR. RUDOLPH M MARIN JR. 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	207Q00000X	Family Medicine Physician	L7032	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

General Provider Information

NPI Number	:	1750321832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUDOLPH M MARIN JR. MD

Provider Business Mailing Address
First Line	:	548 WAUGH DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-2002
Country	:	US
Telephone Number	:	713-933-0501
Fax Number	:	713-933-0505

Provider Business Practice Location Address
First Line	:	548 WAUGH DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-2002
Country	:	US
Telephone Number	:	713-933-0501
Fax Number	:	713-933-0505

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	02/03/2011

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