Individual
PAUL THOMAS MARCIANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1940 E STATE HIGHWAY 114, SUITE 150, SOUTHLAKE, TX 76092-6526
(817) 424-3668
(817) 442-8637
Mailing address
1940 E HWY 114, SUITE 150, SOUTHLAKE, TX 76092-6510
(817) 424-3668
(817) 442-8637
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
1364
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0031NJ
BCBS GROUP
TX
01
—
1346477304
GROUP NPI
—
01
—
1356541346
GROUP NPI
TX
01
—
1376738971
GROUP NPI
—
01
—
1932493574
GROUP NPI
—
01
—
2441376
AETNA
TX
01
—
603978000
WORK COMP ID
TX
01
—
8J0650
BCBS INDV. ID
TX
Enumeration date
03/23/2006
Last updated
05/22/2020
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