Healthcare Provider Details

I. General information

NPI: 1003871914
Provider Name (Legal Business Name): JAY W MARKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST SUITE #880
LOS ANGELES CA
90048-6101
US

IV. Provider business mailing address

2521 MT BEACON TER
LOS ANGELES CA
90068-2444
US

V. Phone/Fax

Practice location:
  • Phone: 323-469-4499
  • Fax:
Mailing address:
  • Phone: 323-469-4499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG21318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: