Provider Demographics
NPI:1841481793
Name:MARIN, ANNETTE LARIE (MD)
Entity type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:LARIE
Last Name:MARIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20522 SADDLEBACK CHASE LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-3618
Mailing Address - Country:US
Mailing Address - Phone:269-277-4597
Mailing Address - Fax:
Practice Address - Street 1:8350 FRY RD STE 1000
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-6927
Practice Address - Country:US
Practice Address - Phone:281-717-6526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD28128207R00000X
TXN5111207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR279265Medicaid
OR279265Medicaid
ORR142564Medicare PIN