Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | N3168 | TX |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | N3168 | TX |
NPI | 1790980068 |
---|---|
Provider Name | Dr. Randall Carter Marx |
First Address | San Antonio, TX 78216-6991 |
Second Address | San Antonio, TX 78229-6015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2007 |
Last Update Date | 13/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
219358301 | (05) | TX |
74-3003947 | TAX ID (01) |