Basic Information
| Provider Information | |||||||||
| NPI: | 1760582647 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VARGAS | ||||||||
| FirstName: | MARCO | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17510 W GRAND PARKWAY SOUTH | ||||||||
| Address2: | SUITE 530 - APPOINTMENTS ONLY | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774793244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813130090 | ||||||||
| FaxNumber: | 8669127672 | ||||||||
| Practice Location | |||||||||
| Address1: | 17510 W GRAND PARKWAY SOUTH -APPOINTMENTS ONLY- | ||||||||
| Address2: | SUITE 530 | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774793244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813428700 | ||||||||
| FaxNumber: | 2812327918 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 08/27/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213EP1101X | 1504 | TX | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine | 213ES0103X | BV6387890 | TX | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.