Provider Demographics
NPI:1851497903
Name:IBANEZ, MARC A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:A
Last Name:IBANEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5424 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4635
Mailing Address - Country:US
Mailing Address - Phone:361-500-1431
Mailing Address - Fax:361-271-1423
Practice Address - Street 1:5424 HOLLY RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4635
Practice Address - Country:US
Practice Address - Phone:361-500-1431
Practice Address - Fax:361-271-1423
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM4188208M00000X, 207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
273706YMVUOtherWELLMED NETWORKS INC PTAN