Provider Demographics
NPI:1255303129
Name:MARNER, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:MARNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:804 KENYON RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5742
Mailing Address - Country:US
Mailing Address - Phone:515-574-6141
Mailing Address - Fax:515-574-6145
Practice Address - Street 1:804 KENYON RD
Practice Address - Street 2:SUITE D
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5742
Practice Address - Country:US
Practice Address - Phone:515-574-6141
Practice Address - Fax:515-574-6145
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2009-12-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA21152207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA110046473OtherRR MEDICARE
IA0006577Medicaid
IA18160OtherBC/BS
IA110046473OtherRR MEDICARE
IA18160Medicare PIN