Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 83936 | SC |
NPI | 1023061769 |
---|---|
Provider Name | Dr. Richard M Marks |
First Address | West Columbia, SC 29169 |
Second Address | West Columbia, SC 29169-4800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 14/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002000226F | HUMANA (01) | |
1023061769 | (05) | WI |
F98570 | (02) |