Provider Demographics
NPI:1619918836
Name:KAPLAN, MARC A (DO)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:A
Last Name:KAPLAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 E WILCOX DR.
Mailing Address - Street 2:#C
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635
Mailing Address - Country:US
Mailing Address - Phone:520-459-0000
Mailing Address - Fax:520-459-5141
Practice Address - Street 1:2585 E WILCOX DR.
Practice Address - Street 2:#C
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635
Practice Address - Country:US
Practice Address - Phone:520-459-0000
Practice Address - Fax:520-459-5141
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1872207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4114163OtherAETNA
AZ255465Medicaid
AZ0779310OtherBCBS AZ
AZE39208Medicare UPIN
AZ255465Medicaid
AZZ103269Medicare PIN