Provider Demographics
NPI:1114195658
Name:DARYL S. MARX M.D., L.L.C.
Entity Type:Organization
Organization Name:DARYL S. MARX M.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-398-9709
Mailing Address - Street 1:3418 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2376
Mailing Address - Country:US
Mailing Address - Phone:318-398-9709
Mailing Address - Fax:318-398-9711
Practice Address - Street 1:3418 MEDICAL PARK DR
Practice Address - Street 2:SUITE 1
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2376
Practice Address - Country:US
Practice Address - Phone:318-398-9709
Practice Address - Fax:318-398-9711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.024323174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4379459970OtherBLUE CROSS BLUE SHIELD
1063462695OtherINDIVIDUAL NPI
LA1570192Medicaid
LA4379459970OtherBLUE CROSS BLUE SHIELD
1063462695OtherINDIVIDUAL NPI