Provider Demographics
NPI:1952728305
Name:DELARA, MARC JOSEPH (DPM)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:JOSEPH
Last Name:DELARA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 HOSPITAL PKWY STE 309
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6931
Mailing Address - Country:US
Mailing Address - Phone:817-793-3422
Mailing Address - Fax:
Practice Address - Street 1:1604 HOSPITAL PKWY
Practice Address - Street 2:STE 309
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6931
Practice Address - Country:US
Practice Address - Phone:817-793-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2291213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery