Provider Demographics
NPI:1407931397
Name:SANCHEZ, MARVIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:DPM
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 40189
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-1189
Mailing Address - Country:US
Mailing Address - Phone:210-849-4457
Mailing Address - Fax:210-949-0960
Practice Address - Street 1:19432 DAVIS STREET
Practice Address - Street 2:
Practice Address - City:LYTLE
Practice Address - State:TX
Practice Address - Zip Code:78052
Practice Address - Country:US
Practice Address - Phone:830-709-9960
Practice Address - Fax:210-949-0960
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1554213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148109501Medicaid
TX00325PMedicare PIN
TXU86751Medicare UPIN
TX148109501Medicaid