Provider Demographics
NPI:1669474128
Name:MARX, DON F (MD)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:F
Last Name:MARX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3510 MAGNOLIA CV
Mailing Address - Street 2:SUITE 170
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2372
Mailing Address - Country:US
Mailing Address - Phone:318-387-9774
Mailing Address - Fax:318-322-7306
Practice Address - Street 1:3510 MAGNOLIA CV
Practice Address - Street 2:SUITE 170
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2372
Practice Address - Country:US
Practice Address - Phone:318-387-9774
Practice Address - Fax:318-322-7306
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12297208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAL190002OtherVANTAGE
LA1192864Medicaid
LA720903504OtherTAX IDENTIFICATION
LA53556Medicare ID - Type Unspecified
LAB64698Medicare UPIN