Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 23190 | MS |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 23190 | MS |
N | 2086S0105X | Surgery of the Hand | 23190 | MS |
NPI | 1659533412 |
---|---|
Provider Name | Mr. Tyler G. Marks |
First Address | Tupelo, MS 38801 |
Second Address | Tupelo, MS 38801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2008 |
Last Update Date | 11/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04722052 | (05) | MS |