MEDICARE: DEBBIE L MARKS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	G58193	CA
2	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1447231220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBBIE L MARKS MD

Provider Business Mailing Address
First Line	:	6 WOODLAND RD
Second Line	:	STE 305
City	:	SAINT HELENA
State	:	CA
Zip	:	94574-9501
Country	:	US
Telephone Number	:	707-963-6548
Fax Number	:	707-963-6546

Provider Business Practice Location Address
First Line	:	275 HOSPITAL DR
Second Line	:
City	:	UKIAH
State	:	CA
Zip	:	95482-4531
Country	:	US
Telephone Number	:	707-462-7900
Fax Number	:	707-462-7947

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	03/25/2008

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