Provider Demographics
NPI:1831147461
Name:MARCUS, TRENT WRIGHT (MD)
Entity type:Individual
Prefix:DR
First Name:TRENT
Middle Name:WRIGHT
Last Name:MARCUS
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 1:612 LEAH LN
Mailing Address - Street 2:
Mailing Address - City:MANILA
Mailing Address - State:AR
Mailing Address - Zip Code:72442-9128
Mailing Address - Country:US
Mailing Address - Phone:870-561-1277
Mailing Address - Fax:
Practice Address - Street 1:5722 INTEGRITY DR
Practice Address - Street 2:BUILDING S771
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38054-5028
Practice Address - Country:US
Practice Address - Phone:901-874-6119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11359207Q00000X
ARR-4476207P00000X
ARR4476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARR-4476OtherARKANSAS LICENSE
NVCC7692OtherBLUE CROSS PROVIDER ID
NV100506021Medicaid
NV11359OtherNEVADA LICENSE
NV100749Medicare PIN
NV11359OtherNEVADA LICENSE