Provider Demographics
NPI:1326072505
Name:MARMEL, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MARMEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 274
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78291-0274
Mailing Address - Country:US
Mailing Address - Phone:210-614-4711
Mailing Address - Fax:210-614-4761
Practice Address - Street 1:8042 WURZBACH RD
Practice Address - Street 2:STE 260
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3818
Practice Address - Country:US
Practice Address - Phone:210-614-4711
Practice Address - Fax:210-614-4761
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4904207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133161307Medicaid
N19KOtherBCBS INDIV
N19KOtherBCBS INDIV
B88824Medicare UPIN