Individual
MAURICE G SYRQUIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3414 OAK GROVE AVE, DALLAS, TX 75204-2375
(214) 521-1153
(214) 219-3651
Mailing address
3414 OAK GROVE AVE, DALLAS, TX 75204-2375
(214) 521-1153
(214) 219-3651
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
73015
MA
207W00000X
Ophthalmology Physician
G69442
CA
207W00000X
Ophthalmology Physician
H9162
TX
207WX0107X
Retina Specialist (Ophthalmology) Physician
73015
MA
207WX0107X
Retina Specialist (Ophthalmology) Physician
G69442
CA
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
H9162
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128119804
—
TX
05
—
128119806
—
TX
05
—
128119807
—
TX
01
—
180043891
RR MEDICARE GRP CJ5857
TX
05
—
200052580A
—
OK
01
—
5365042
AETNA
TX
01
—
805833
BCBS/GRP 00T587
TX
Enumeration date
05/03/2006
Last updated
07/23/2024
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