Provider Demographics
NPI:1205818853
Name:MAYER, MARILYN BARBARA (MD)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:BARBARA
Last Name:MAYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21216 NORTHWEST FWY
Mailing Address - Street 2:SUITE 560
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4695
Mailing Address - Country:US
Mailing Address - Phone:281-469-3949
Mailing Address - Fax:281-469-4572
Practice Address - Street 1:21216 NORTHWEST FWY
Practice Address - Street 2:SUITE 560
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-4695
Practice Address - Country:US
Practice Address - Phone:281-469-3949
Practice Address - Fax:281-469-4572
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ2191207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF58591Medicare UPIN
TX00U33HMedicare ID - Type Unspecified