Provider Demographics
NPI:1013966837
Name:PERCY, MARIE (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:PERCY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 N LEE TREVINO DR STE A3
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3419
Mailing Address - Country:US
Mailing Address - Phone:915-594-2772
Mailing Address - Fax:915-594-2774
Practice Address - Street 1:2200 N LEE TREVINO DR STE A3
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-3419
Practice Address - Country:US
Practice Address - Phone:915-594-2772
Practice Address - Fax:915-594-2774
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4197207P00000X, 207Q00000X
IN01048545A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH59557Medicare UPIN