Provider Demographics
NPI:1164777298
Name:PARKE, MARION GARRETT (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARION
Middle Name:GARRETT
Last Name:PARKE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 OLD LANDING RD
Mailing Address - Street 2:
Mailing Address - City:TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920-1109
Mailing Address - Country:US
Mailing Address - Phone:847-363-6464
Mailing Address - Fax:
Practice Address - Street 1:599 SIR FRANCIS DRAKE BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1712
Practice Address - Country:US
Practice Address - Phone:415-461-6555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-15
Last Update Date:2012-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE-5020213EP0504X, 213EP1101X, 213ER0200X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE-5020OtherSTATE OF CALIFORNIA DPM LICENSE