Provider Demographics
NPI:1568547719
Name:OZAETA, MARCUS S (MD)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:S
Last Name:OZAETA
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 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-6163
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:5708 EDWARDS RANCH RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4115
Practice Address - Country:US
Practice Address - Phone:817-336-4040
Practice Address - Fax:817-336-6780
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7467208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U87ZOtherBCBSTX GRP PIN
TX140442893Medicaid
TX2225865OtherUHC PIN
TXOZAM461710OtherCCHIP PIN
TX157551602Medicaid
TX7398039OtherAETNA PIN
TX9075755OtherPHC SPIN
TX2146980OtherFIRSTHEALTH PIN
TX8K3190OtherBCBSTX IND PIN
TX145854100OtherFIRSTCARE PIN
TX140442852Medicaid
1750369203OtherGRP NPI NUMBER
TX00U87ZOtherBCBSTX GRP PIN
1750369203OtherGRP NPI NUMBER
TX140442893Medicaid