Provider Demographics
NPI:1750556304
Name:MARKS, LACEY M (MD)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:M
Last Name:MARKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:M
Other - Last Name:LABARGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3649
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-3649
Mailing Address - Country:US
Mailing Address - Phone:509-838-2531
Mailing Address - Fax:509-755-6580
Practice Address - Street 1:910 W 5TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2966
Practice Address - Country:US
Practice Address - Phone:509-838-2531
Practice Address - Fax:509-755-6580
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ81750207V00000X
MA246639207V00000X
WAMD60461290207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110088998AMedicaid
81750OtherTRAINING PERMIT
81750OtherTRAINING PERMIT