Charles D. Demarque, MD, PA

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

J1969 Issued in TX

Legal business name

CHARLES D. DEMARQUE, MD, PA

Practice address

4020 N Macarthur Blvd
Suite 122-286
Irving, TX 75038-6419

Phone

(817) 308-8477

NPI assigned

Jul 24, 2013

Organization subpart

No

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

Authorized official

Name

Charles D. Demarque

Title

Medical Director

Phone

(817) 308-8477

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1374624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374624000000",
    "number": "1649612110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4020 N MACARTHUR BLVD",
            "address_2": "SUITE 122-286",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750386419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4020 N MACARTHUR BLVD",
            "address_2": "SUITE 122-286",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750386419",
            "telephone_number": "817-308-8477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES D. DEMARQUE, MD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-24",
        "last_updated": "2013-07-24",
        "status": "A",
        "authorized_official_last_name": "DEMARQUE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "817-308-8477"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "TX",
            "license": "J1969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2013; 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.