Provider Demographics
NPI:1578589602
Name:MARKS, GEORGE LEONARD (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:LEONARD
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 1:866 N VERMONT AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-3587
Mailing Address - Country:US
Mailing Address - Phone:323-906-0050
Mailing Address - Fax:323-906-0060
Practice Address - Street 1:866 N VERMONT AVE STE 3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-3587
Practice Address - Country:US
Practice Address - Phone:323-906-0050
Practice Address - Fax:323-906-0060
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC39879207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA88144Medicare UPIN
CAC39879Medicare ID - Type UnspecifiedPROVIDER NO.