Provider Demographics
NPI:1649202730
Name:MARX, ROBERT DARYL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DARYL
Last Name:MARX
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 1:102 THOMAS RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7366
Mailing Address - Country:US
Mailing Address - Phone:318-329-8464
Mailing Address - Fax:318-329-8467
Practice Address - Street 1:102 THOMAS RD
Practice Address - Street 2:SUITE 108
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7366
Practice Address - Country:US
Practice Address - Phone:318-329-8464
Practice Address - Fax:318-329-8467
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015584208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1358690Medicaid
LA1358690Medicaid
LA5DR07Medicare PIN
LA51354DR07Medicare PIN