Provider Demographics
NPI:1881779007
Name:MARCK, GEORGE J (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:J
Last Name:MARCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1215 S COULTER ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1758
Mailing Address - Country:US
Mailing Address - Phone:806-358-1374
Mailing Address - Fax:806-356-0045
Practice Address - Street 1:1215 S COULTER ST
Practice Address - Street 2:SUITE 305
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1758
Practice Address - Country:US
Practice Address - Phone:806-358-1374
Practice Address - Fax:806-356-0045
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG7553207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114749802Medicaid
TX114749802Medicaid
TX88923KMedicare ID - Type Unspecified