Provider Demographics
NPI:1336451095
Name:MARKS, BECCA J (DO)
Entity Type:Individual
Prefix:DR
First Name:BECCA
Middle Name:J
Last Name:MARKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 25317
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-5317
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:3438 LAWTON RD STE 2B
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-2948
Practice Address - Country:US
Practice Address - Phone:407-868-8451
Practice Address - Fax:407-868-8495
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12797207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012881700Medicaid
FLHW387ZOtherMEDICARE