Healthcare Provider Details

I. General information

NPI: 1821159815
Provider Name (Legal Business Name): MARCUS GAYLAND CAUGHRON D.C., N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 VIRGINIA PL
PORT LAVACA TX
77979-2510
US

IV. Provider business mailing address

4906 PARK PLAZA DR
HOUSTON TX
77018-1429
US

V. Phone/Fax

Practice location:
  • Phone: 361-551-2273
  • Fax: 361-552-1782
Mailing address:
  • Phone: 361-920-2468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7271
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number776966
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP120378
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: