Provider Demographics
NPI:1841206216
Name:POQUIZ, RAYMUND MART (MD)
Entity Type:Individual
Prefix:
First Name:RAYMUND
Middle Name:MART
Last Name:POQUIZ
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 1:1500 OAKLAND PL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103-1550
Mailing Address - Country:US
Mailing Address - Phone:817-652-3395
Mailing Address - Fax:817-263-8878
Practice Address - Street 1:1500 OAKLAND PL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-1550
Practice Address - Country:US
Practice Address - Phone:817-652-3395
Practice Address - Fax:817-263-8878
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2986208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168720401Medicaid
TX168720401Medicaid