| East Plano Family Clinic | |
|
2380 E Park Blvd Suite 300 Plano TX 75074-5151 | |
| (972) 633-8747 | |
| (972) 633-8356 |
| Full Name | East Plano Family Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 2380 E Park Blvd, Plano, Texas |
| Authorized Official Name and Position | Nohora Marin (OFFICE MANAGER) |
| Authorized Official Contact | 9726338747 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Plano Family Clinic 2380 E Park Blvd Suite 300 Plano TX 75074-5151 Ph: (972) 633-8747 | East Plano Family Clinic 2380 E Park Blvd Suite 300 Plano TX 75074-5151 Ph: (972) 633-8747 |
| NPI Number | 1396804514 |
|---|---|
| Provider Enumeration Date | 12/06/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0446296966 |
|---|---|
| Medicare Enrollment ID | O20050706000317 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396804514 | NPI | - | NPPES |
| 10027616 | Other | TX | AMERIGROUP GROUP NUMBER |
| 13085 | Other | TX | PARKLAND GROUP NUMBER |
| H08V4391 | Other | TX | BLUE CROSS BLUE SHIELD IN |
| 0086NL | Other | TX | BLUE CROSS BLUE SHIELD GR |
| 8V4390 | Other | TX | BLUE CROSS BLUE SHIELD IN |
| 434703 | Other | TX | AETNA INDIVIDUAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | E0540 (Texas) | Primary |
| Provider Name | Yiqun Wu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417920281 PECOS PAC ID: 1850383498 Enrollment ID: I20040401001471 |
| Provider Name | Gustavo Marin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396706628 PECOS PAC ID: 7517903032 Enrollment ID: I20050706000334 |
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