Individual
MARRIETTA D. CLINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
624 FM 517 RD W, DICKINSON, TX 77539-3904
(281) 534-1300
(281) 534-1306
Mailing address
624 FM 517 RD W, DICKINSON, TX 77539-3904
(281) 534-1300
(281) 534-1306
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
K1399
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00002
AETNA EDI PROVIDER ID
TX
01
—
0017QD
BC/BS
TX
01
—
00424
TEXAS CHIP
TX
01
—
00606G
MEDICARE ID
TX
01
—
10024877
AMERIGROUP
TX
05
—
121246602
—
TX
05
—
121246604
—
TX
Enumeration date
07/03/2006
Last updated
07/10/2023
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