Provider Demographics
NPI:1437111382
Name:MARRS, CHAD R (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:R
Last Name:MARRS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5432 BEE RIDGE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1514
Mailing Address - Country:US
Mailing Address - Phone:941-379-3277
Mailing Address - Fax:941-379-6277
Practice Address - Street 1:5432 BEE RIDGE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1514
Practice Address - Country:US
Practice Address - Phone:941-379-3277
Practice Address - Fax:941-379-6277
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114119207Y00000X
MO2002029296207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLW44C210OtherPTAN
FL007334700Medicaid
FLW44C210OtherMEDICARE PTAN
MOH77829Medicare UPIN
MO7727419OtherAETNA
MOH77829Medicare UPIN
KSW44C210AMedicare ID - Type UnspecifiedKS MEDICARE
MOBM8173104OtherDEA
KS100457770CMedicaid
MO2317823OtherUNITED HEALTHCARE
MO248579996OtherBNDD