Provider Demographics
NPI:1801822911
Name:HOUSTON, MARC R (DO)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:R
Last Name:HOUSTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2505
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97308-2505
Mailing Address - Country:US
Mailing Address - Phone:888-828-3198
Mailing Address - Fax:
Practice Address - Street 1:665 WINTER ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3919
Practice Address - Country:US
Practice Address - Phone:503-561-5634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO25184207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR277885Medicaid
277885OtherMARION POLK CHP
I15163OtherPROVIDENCE
I15163OtherGROUP HEALTH
0142246OtherWA L&I
WA8416935Medicaid
CAXYP202200Medicaid
0142246OtherWA L&I
I15163OtherGROUP HEALTH
I15163OtherPROVIDENCE