Provider Demographics
NPI:1700820743
Name:ROUX, MARCUS ANDERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:ANDERSON
Last Name:ROUX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARC
Other - Middle Name:A
Other - Last Name:ROUX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:800 ORTHOPEDIC WAY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-1629
Mailing Address - Country:US
Mailing Address - Phone:817-375-5200
Mailing Address - Fax:
Practice Address - Street 1:1328 W HWY 287 BYP STE 100
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5257
Practice Address - Country:US
Practice Address - Phone:817-375-5200
Practice Address - Fax:817-299-1706
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5115207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153433105Medicaid
TX8S4590OtherBCBS
TX8BR083OtherBCBS
TX153433104Medicaid
TX8BR083OtherBCBS
TX153433104Medicaid
TXP00709063Medicare PIN
TX8L5649Medicare PIN
H69554Medicare UPIN
TX6456330001Medicare NSC