Provider Demographics
NPI:1720089790
Name:MARKS, ERIC ADAM (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ADAM
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 1:810 HOSPITAL DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4600
Mailing Address - Country:US
Mailing Address - Phone:409-835-0905
Mailing Address - Fax:409-839-4723
Practice Address - Street 1:810 HOSPITAL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4600
Practice Address - Country:US
Practice Address - Phone:409-835-0905
Practice Address - Fax:409-839-4723
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3325207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89271SOtherBCBS
TX89420KOtherMEDICARE PERFORMING PROVIDER
TX096395101Medicaid
TX096395101Medicaid