Modoma Physical Medicine

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

MODOMA PHYSICAL MEDICINE

Practice address

5301 Village Creek Dr
Suite B
Plano, TX 75093-4838

Phone

(972) 250-3443

NPI assigned

Oct 27, 2014

Last updated

Oct 27, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Charles Demarque, MDNPI 1659315828

Title

Medical Director

Phone

(817) 308-8477

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Charles Dan Demarque, M.D.

  • Emergency Medicine Physician
  • Irving, TX
  • NPI 1659315828
  Authorized official Same address or phone

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

{
    "created_epoch": "1414368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414368000000",
    "number": "1538564018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4020 N MACARTHUR BLVD",
            "address_2": "#122-286",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750386419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 VILLAGE CREEK DR",
            "address_2": "SUITE B",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750934838",
            "telephone_number": "972-250-3443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODOMA PHYSICAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-27",
        "last_updated": "2014-10-27",
        "status": "A",
        "authorized_official_last_name": "DEMARQUE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "817-308-8477",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Modern Dental Professionals, Oklahoma P.C. (Monarch Dental)
• Modern Sleep Solutions PLLC (Sleep Rehab)
• Modern Vue Eyecare PLLC
• Gunjan M Modi, M.D.
• Seema C Modi, MD
• Hunter Moehnke
• Mary Moga
• Adrian C. Moger, M.D.
• Taraneh M Moghimi, LPC, NCC.
• Asmaa A Mohamed

• Clinic/Center in Plano, TX
• Providers in Plano, TX by specialty
• Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.