Provider Demographics
NPI:1376604777
Name:ALEXANDER, MARLON J (PA-C)
Entity Type:Individual
Prefix:
First Name:MARLON
Middle Name:J
Last Name:ALEXANDER
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 1:6400 FANNIN ST STE 1700
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1526
Mailing Address - Country:US
Mailing Address - Phone:713-486-3212
Mailing Address - Fax:713-500-0702
Practice Address - Street 1:6400 FANNIN ST STE 1700
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1526
Practice Address - Country:US
Practice Address - Phone:713-486-3212
Practice Address - Fax:713-512-7237
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA.200012.RX363A00000X
LAPA.200012.RX363AS0400X
TXPA06523363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
815N08OtherBCBS OF TX
TX1376604777Medicaid
TX210004201Medicaid
LAP626Medicare ID - Type Unspecified
TX210004201Medicaid