Organization
MODOMA PHYSICAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES DEMARQUE MD (MEDICAL DIRECTOR)
(817) 308-8477
Entity
Organization
Contact information
Practice address
5301 VILLAGE CREEK DR, SUITE B, PLANO, TX 75093-4838
(972) 250-3443
Mailing address
4020 N MACARTHUR BLVD, #122-286, IRVING, TX 75038-6419
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
10/27/2014
Last updated
10/27/2014
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