Provider Demographics
NPI:1457855793
Name:MARKS, STANLEY WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:WILLIAM
Last Name:MARKS
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 1:3111 STIRLING RD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-6566
Mailing Address - Country:US
Mailing Address - Phone:954-265-5936
Mailing Address - Fax:954-265-7749
Practice Address - Street 1:3111 STIRLING RD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6566
Practice Address - Country:US
Practice Address - Phone:954-265-5936
Practice Address - Fax:954-265-7749
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25803208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery