Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 12110 | NH |
NPI | 1013924240 |
---|---|
Provider Name | Dr. Douglas F. Marks JR. |
First Address | Manchester, NH 03102-3765 |
Second Address | Manchester, NH 03102-3765 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 20/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013262 | (05) | VT |
30206364 | (05) | NH |
I66498 | (02) |