Provider Demographics
NPI:1710958103
Name:MARXER, DONALD P (PA)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:P
Last Name:MARXER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:DONALD
Other - Middle Name:PAUL
Other - Last Name:MARXER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:11636 COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-2643
Mailing Address - Country:US
Mailing Address - Phone:405-692-1818
Mailing Address - Fax:
Practice Address - Street 1:11636 COUNTRY DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-2643
Practice Address - Country:US
Practice Address - Phone:405-692-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200021270AMedicaid
OKR10942Medicare UPIN
OK200021270AMedicaid