Provider Demographics
NPI:1184631046
Name:MARCUM, KEVIN S (PA-C)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:S
Last Name:MARCUM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2313
Mailing Address - Country:US
Mailing Address - Phone:361-883-4323
Mailing Address - Fax:361-883-4324
Practice Address - Street 1:1227 3RD ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2313
Practice Address - Country:US
Practice Address - Phone:361-883-4323
Practice Address - Fax:361-883-4324
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04836363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y0857OtherBCBS
TX8F8732Medicare PIN