Healthcare Provider Details

I. General information

NPI: 1013268200
Provider Name (Legal Business Name): LIONEL P MARX PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 08/16/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9361 SE 82ND AVE
HAPPY VALLEY OR
97086-3645
US

IV. Provider business mailing address

9361 SE 82ND AVE
HAPPY VALLEY OR
97086-3645
US

V. Phone/Fax

Practice location:
  • Phone: 971-202-2090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA160239
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA160239
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierPA160239
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerPA LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: