Provider Demographics
NPI:1164407128
Name:MARKS, KRISTEN L (DO)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:MARKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 CAUBLESTONE HILL DR
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-6873
Mailing Address - Country:US
Mailing Address - Phone:480-231-9970
Mailing Address - Fax:
Practice Address - Street 1:3301 MATLOCK RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2908
Practice Address - Country:US
Practice Address - Phone:682-509-4540
Practice Address - Fax:682-509-4541
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3640207P00000X
TXQ3566207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ625428Medicaid
AZ625428Medicaid
AZ69248Medicare ID - Type Unspecified