Organization
ST. MATTHEW DERMATOLOGY CLINIC, P.A.
Active
Organization
ST. MATTHEW DERMATOLOGY CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RENATO MARQUEZ ORACION M.D. (PRESIDENT)
(432) 582-0370
Entity
Organization
Contact information
Practice address
808 TOWER DR STE 3, ODESSA, TX 79761-4256
(432) 582-0370
Mailing address
808 TOWER DR STE 3, ODESSA, TX 79761-4256
(432) 582-0370
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
L4085
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0099KK
BLUE CROSS BLUE SHIELD
TX
01
—
DB7529
RAILROAD MEDICARE
TX
Enumeration date
11/18/2007
Last updated
04/20/2008
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