Provider Demographics
NPI:1134102668
Name:MARRIOTT, JOHN T (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:MARRIOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 GROGANS POINT RD
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2620
Mailing Address - Country:US
Mailing Address - Phone:281-292-7227
Mailing Address - Fax:281-292-3961
Practice Address - Street 1:62 GROGANS POINT RD
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2620
Practice Address - Country:US
Practice Address - Phone:281-292-7227
Practice Address - Fax:281-292-3961
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK93432085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84214RMedicare ID - Type Unspecified
E76056Medicare UPIN