Healthcare Provider Details

I. General information

NPI: 1447222617
Provider Name (Legal Business Name): THOMAS J MARR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8170 33RD AVE S MS 21110X
BLOOMINGTON MN
55425-4516
US

IV. Provider business mailing address

8170 33RD AVE S MS 21110X
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-883-7844
  • Fax: 952-883-6380
Mailing address:
  • Phone: 952-883-7844
  • Fax: 952-883-6380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number32321
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: