Provider Demographics
NPI:1679504849
Name:DANCEL, MARIETTA F (MD)
Entity Type:Individual
Prefix:
First Name:MARIETTA
Middle Name:F
Last Name:DANCEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 301173
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75303-1173
Mailing Address - Country:US
Mailing Address - Phone:281-837-2700
Mailing Address - Fax:281-837-2760
Practice Address - Street 1:1602 GARTH RD
Practice Address - Street 2:250
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-2410
Practice Address - Country:US
Practice Address - Phone:281-837-2700
Practice Address - Fax:281-837-2760
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF8108207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134240401OtherCSHCN
TX080152127OtherRAILROAD MEDICARE
TX88Y307OtherBCBS
TX134240406Medicaid
TX134240406Medicaid
TX88Y307Medicare PIN