Provider Demographics
NPI:1013359835
Name:MARKER, ERIK DAVID
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:DAVID
Last Name:MARKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W215N10364 LAUREL CT
Mailing Address - Street 2:
Mailing Address - City:COLGATE
Mailing Address - State:WI
Mailing Address - Zip Code:53017-9513
Mailing Address - Country:US
Mailing Address - Phone:262-894-8301
Mailing Address - Fax:
Practice Address - Street 1:3402 TARAWA RD
Practice Address - Street 2:BLDG 19
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92155-5176
Practice Address - Country:US
Practice Address - Phone:619-437-2558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIM626-2048-5059-051710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman