Provider Demographics
NPI:1891094843
Name:DON F MARX MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DON F MARX MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:F
Authorized Official - Last Name:MARX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-387-9774
Mailing Address - Street 1:3510 MAGNOLIA CV
Mailing Address - Street 2:STE 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:STE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011481208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1192864Medicaid
LA4337007690OtherBCBS OF LA
LA53556Medicare PIN
LA1192864Medicaid