Provider Demographics
NPI:1962479352
Name:MARKS, HOWARD C (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:C
Last Name:MARKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 E NORTH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-4960
Mailing Address - Country:US
Mailing Address - Phone:209-239-0515
Mailing Address - Fax:209-239-0504
Practice Address - Street 1:1234 E NORTH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-4960
Practice Address - Country:US
Practice Address - Phone:209-239-0515
Practice Address - Fax:209-239-0504
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG49155207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92878Medicare UPIN
CA00G491550Medicare ID - Type Unspecified