Provider Demographics
NPI:1255398293
Name:MANQUERO-BUTLER, MARTHA (MD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:MANQUERO-BUTLER
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 1:3615 RUTHERGLEN ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-1416
Mailing Address - Country:US
Mailing Address - Phone:915-772-5400
Mailing Address - Fax:915-772-5402
Practice Address - Street 1:1316 N YARBROUGH DR
Practice Address - Street 2:STE. 1 A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7800
Practice Address - Country:US
Practice Address - Phone:915-772-5400
Practice Address - Fax:915-772-5402
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4556207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXY0125199OtherDPS
TXBM7928027OtherDEA