St. Matthew Dermatology Clinic, P.a.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

L4085 Issued in TX

Legal business name

ST. MATTHEW DERMATOLOGY CLINIC, P.A.

Practice address

808 Tower Dr Ste 3
Odessa, TX 79761-4256

Phone

(432) 582-0370

NPI assigned

Nov 18, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Renato Marquez Oracion, M.D.NPI 1154309052

Title

President

Phone

(432) 582-0370

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Renato Marquez Oracion, M.D.

  • Dermatology Physician
  • Odessa, TX
  • NPI 1154309052
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1457532442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 TOWER DR STE 3",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797614256",
            "telephone_number": "432-582-0370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 TOWER DR STE 3",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797614256",
            "telephone_number": "432-582-0370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MATTHEW DERMATOLOGY CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-18",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "ORACION",
        "authorized_official_first_name": "RENATO",
        "authorized_official_middle_name": "MARQUEZ",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "432-582-0370",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "TX",
            "license": "L4085",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0099KK",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DB7529",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Odessa, TX
• Providers in Odessa, TX by specialty
• Dermatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.