Unknown Individual – Family Medicine Physician, NPI 1124180724

Family Medicine Physician

Unknown Individual is a healthcare provider. based in Marfa, Texas. specializing in Family Medicine Physician. They hold a License No. G0083 (TX). The NPI Number for Unknown Individual is 1124180724

Main info

Organization

Inactive

45 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1124180724

Phone

(432) 729-3000

Address

PO BOX 368

Deactivation Date

19 June 2025

Doctor Profile

Medical School Name

UNIVERSITY OF NORTH TEXAS HSC, COLLEGE OF OSTEOPATHIC MED

Secondary Phone

4327293000

Graduation Year

1981 (45 years ago)

PAC ID

1355479759

Group Practice PAC ID

2567590953

Professional Enrollment ID

I20100505000646

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

PO BOX 368
MARFA, TX 798430368
Phone: (432) 729-3000
Fax: (432) 729-3001
Type: Mailing
105, East Oak Street, Marfa, Presidio County, Texas, 79843, United States
MARFA, TX 79843
Phone: (432) 729-3000
Fax: (432) 729-3001
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 79843)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 2567590953View full group profile