Provider Demographics
NPI:1285018036
Name:BRIGGS, MARCUS LYNN
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:LYNN
Last Name:BRIGGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MARCUS
Other - Middle Name:LYNN
Other - Last Name:BRIGGS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:16851 EAGLE PEAK RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-8808
Mailing Address - Country:US
Mailing Address - Phone:951-789-2914
Mailing Address - Fax:
Practice Address - Street 1:16851 EAGLE PEAK RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-8808
Practice Address - Country:US
Practice Address - Phone:951-789-2914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45400302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMEDICAIDMedicaid