Healthcare Provider Details

I. General information

NPI: 1316046329
Provider Name (Legal Business Name): MARILYN MARX M.D., M.B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555-0531
US

IV. Provider business mailing address

301 UNIVERSITY BLVD
GALVESTON TX
77555-0531
US

V. Phone/Fax

Practice location:
  • Phone: 409-747-7359
  • Fax: 409-747-7378
Mailing address:
  • Phone: 409-747-7359
  • Fax: 409-747-7378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG6212
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberG6212
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: