Provider Demographics
NPI:1629697230
Name:MEDRANO, MARCUS ANTHONY SR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:ANTHONY
Last Name:MEDRANO
Suffix:SR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LA FERIA
Mailing Address - State:TX
Mailing Address - Zip Code:78559-5003
Mailing Address - Country:US
Mailing Address - Phone:956-797-2002
Mailing Address - Fax:
Practice Address - Street 1:106 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LA FERIA
Practice Address - State:TX
Practice Address - Zip Code:78559-5003
Practice Address - Country:US
Practice Address - Phone:956-797-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant