MEDICARE: DR MARCO A. VARGAS, PA

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	213E00000X	Podiatrist	1504	TX

General Provider Information

NPI Number	:	1841673506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR MARCO A. VARGAS, PA

Provider Business Mailing Address
First Line	:	17510 W GRAND PARKWAY S
Second Line	:	SUITE 530
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-3244
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17510 W GRAND PARKWAY S
Second Line	:	SUITE 530
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-3244
Country	:	US
Telephone Number	:	281-313-0090
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	STACY MARTIN
Credential	:
Telephone Number	:	973-946-6857

Provider Enumeration Date	:	06/30/2015
Last Update Date	:	08/19/2015

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