Provider Demographics
NPI:1134292675
Name:EPPS, MARCUS DEWAYNE (PA)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:DEWAYNE
Last Name:EPPS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 EWART AVE
Mailing Address - Street 2:APT. 91
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3444
Mailing Address - Country:US
Mailing Address - Phone:304-993-8164
Mailing Address - Fax:
Practice Address - Street 1:505 CAPITOL ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1220
Practice Address - Country:US
Practice Address - Phone:304-722-8822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01247363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical