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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