Provider Demographics
NPI:1073754719
Name:MARCI A. ROY, M. D., PLLC
Entity Type:Organization
Organization Name:MARCI A. ROY, M. D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCI
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-467-7770
Mailing Address - Street 1:5656 BEE CAVE RD
Mailing Address - Street 2:J-202
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5280
Mailing Address - Country:US
Mailing Address - Phone:512-467-7770
Mailing Address - Fax:512-685-5115
Practice Address - Street 1:3101 HIGHWAY 71 E
Practice Address - Street 2:SUITE 201
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-5156
Practice Address - Country:US
Practice Address - Phone:512-467-7770
Practice Address - Fax:512-685-5115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5635174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG27475Medicare UPIN