Provider Demographics
NPI:1720175177
Name:MARKS, TIMOTHY N (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:N
Last Name:MARKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TIMOTHY
Other - Middle Name:NEIL
Other - Last Name:MARKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3910 FAIRMONT PKWY
Mailing Address - Street 2:SUITE G
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-3076
Mailing Address - Country:US
Mailing Address - Phone:281-487-8177
Mailing Address - Fax:
Practice Address - Street 1:3910 FAIRMONT PKWY
Practice Address - Street 2:SUITE G
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-3076
Practice Address - Country:US
Practice Address - Phone:281-487-8177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3719207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130409910Medicaid
F58053Medicare UPIN
TX8G4670Medicare UPIN
TX130409910Medicaid
TX8836B9Medicare ID - Type UnspecifiedGAC MCARE