Provider Demographics
NPI:1609871334
Name:MARGOLIS, WAYNE S (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:S
Last Name:MARGOLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WAYNE
Other - Middle Name:S
Other - Last Name:MARGOLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:740 HOSPITAL DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4664
Mailing Address - Country:US
Mailing Address - Phone:409-835-4003
Mailing Address - Fax:409-835-7005
Practice Address - Street 1:740 HOSPITAL DR
Practice Address - Street 2:SUITE 260
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4664
Practice Address - Country:US
Practice Address - Phone:409-835-4003
Practice Address - Fax:409-835-7005
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF 9775207RC0200X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1493975-01Medicaid
TX1493975-01Medicaid
TXC18780Medicare UPIN