Basic Information
Provider Information
NPI: 1285830547
EntityType: 2
ReplacementNPI:  
OrganizationName: DR. MARCO A. VARGAS P.A
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: FAMILY FOOT CLINIC
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 17510 W GRAND PARKWAY SOUTH
Address2: SUITE 530
City: SUGAR LAND
State: TX
PostalCode: 774793244
CountryCode: US
TelephoneNumber: 2813130090
FaxNumber: 2812327918
Practice Location
Address1: 17510 W GRAND PARKWAY SOUTH
Address2: SUITE 530
City: SUGAR LAND
State: TX
PostalCode: 774793244
CountryCode: US
TelephoneNumber: 2813130090
FaxNumber: 2812327918
Other Information
ProviderEnumerationDate: 06/25/2007
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: DIMAS
AuthorizedOfficialFirstName: PRISCILLA
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: OFFICE MANAGER
AuthorizedOfficialTelephone: 2813130030
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
213E00000X  Y193400000X SINGLE SPECIALTY GROUPPodiatric Medicine & Surgery Service ProvidersPodiatrist 

No ID Information.


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