Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 2367 | LA |
NPI | 1508877580 |
---|---|
Provider Name | Dr. Ronald B Marks |
First Address | Alexandria, LA 71301 |
Second Address | Alexandria, LA 71301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
136654 | UCCI (01) | |
H2059 | BCBS (01) | LA |
T69582 | (02) |