Provider Demographics
NPI:1225333156
Name:JASON E. MARKER, M.D., P.C.
Entity Type:Organization
Organization Name:JASON E. MARKER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:MARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-633-4511
Mailing Address - Street 1:66642 SRTATE ROAD 331
Mailing Address - Street 2:P.O. BOX 90
Mailing Address - City:WYATT
Mailing Address - State:IN
Mailing Address - Zip Code:46595
Mailing Address - Country:US
Mailing Address - Phone:574-633-4511
Mailing Address - Fax:574-633-0281
Practice Address - Street 1:66642 SRTATE ROAD 331
Practice Address - Street 2:
Practice Address - City:WYATT
Practice Address - State:IN
Practice Address - Zip Code:46595
Practice Address - Country:US
Practice Address - Phone:574-633-4511
Practice Address - Fax:574-633-0281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050905207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty