Provider Demographics
NPI:1649263518
Name:PADILLA, MARLON D (MD)
Entity type:Individual
Prefix:DR
First Name:MARLON
Middle Name:D
Last Name:PADILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8611 HILLCREST AVE STE 180
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-4214
Mailing Address - Country:US
Mailing Address - Phone:214-368-3800
Mailing Address - Fax:214-360-7724
Practice Address - Street 1:8611 HILLCREST AVE
Practice Address - Street 2:SUITE 180
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-4207
Practice Address - Country:US
Practice Address - Phone:214-368-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2254207P00000X, 207PE0005X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124905408Medicaid
613805Medicare PIN
TXA93480Medicare UPIN