Healthcare Provider Details

I. General information

NPI: 1730159369
Provider Name (Legal Business Name): HERMAN MARX SACKS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3661 SANGANI BLVD STE E
DIBERVILLE MS
39540-8707
US

IV. Provider business mailing address

15571 STEWART RD
BILOXI MS
39532-6078
US

V. Phone/Fax

Practice location:
  • Phone: 228-354-0022
  • Fax: 228-354-0088
Mailing address:
  • Phone: 228-209-0928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO-422
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: