Provider Demographics
NPI:1821159815
Name:CAUGHRON, MARCUS GAYLAND (DC, NP)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:GAYLAND
Last Name:CAUGHRON
Suffix:
Gender:M
Credentials:DC, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4906 PARK PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-1429
Mailing Address - Country:US
Mailing Address - Phone:361-920-2468
Mailing Address - Fax:
Practice Address - Street 1:2 VIRGINIA PL
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-2510
Practice Address - Country:US
Practice Address - Phone:361-551-2273
Practice Address - Fax:361-552-1782
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7271111N00000X
TX776966363LF0000X
TXAP120378363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8P8480OtherBCBS
TX3199091OtherAETNA
TXDR9334OtherRAILROAD BCBS
TX8P8480OtherBCBS
TXDR9334OtherRAILROAD BCBS