Basic Information
| Provider Information | |||||||||
| NPI: | 1013966837 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERCY | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6090 SURETY DR STE 420 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799052057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9153039215 | ||||||||
| FaxNumber: | 9153039216 | ||||||||
| Practice Location | |||||||||
| Address1: | 1475 GEORGE DIETER DR STE L1 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799367634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152283008 | ||||||||
| FaxNumber: | 9153516600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2006 | ||||||||
| LastUpdateDate: | 06/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | L4197 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 01048545A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | L4197 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.