Provider Demographics
NPI:1942454228
Name:DEVRIES, MARILYN S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:S
Last Name:DEVRIES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 ISLAND DR STE A
Mailing Address - Street 2:# 440
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94502-6700
Mailing Address - Country:US
Mailing Address - Phone:510-865-1145
Mailing Address - Fax:
Practice Address - Street 1:875 ISLAND DR STE A
Practice Address - Street 2:# 440
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94502-6700
Practice Address - Country:US
Practice Address - Phone:510-421-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7886207P00000X
CAG41259207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine