Provider Demographics
NPI:1487628293
Name:MOREAU, MARC (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:MOREAU
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 1:1901 PORT LN
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2430
Mailing Address - Country:US
Mailing Address - Phone:806-358-4596
Mailing Address - Fax:806-358-6726
Practice Address - Street 1:1901 PORT LN
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2430
Practice Address - Country:US
Practice Address - Phone:806-358-4596
Practice Address - Fax:806-468-0240
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7102207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE76824Medicare UPIN
TX8C8871Medicare ID - Type UnspecifiedMEDICARE NUMBER