Provider Demographics
NPI:1598173833
Name:MARKS, KARRIE EUBANK (LMT)
Entity Type:Individual
Prefix:
First Name:KARRIE
Middle Name:EUBANK
Last Name:MARKS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12129 RANCH ROAD 620 N STE 540
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1096
Mailing Address - Country:US
Mailing Address - Phone:512-887-2545
Mailing Address - Fax:
Practice Address - Street 1:12129 RANCH ROAD 620 N STE 540
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1096
Practice Address - Country:US
Practice Address - Phone:512-887-2545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT112391174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist