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General NPI Number Information
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NPI Number | 1407852353
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Entity Type | Individual
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Provider Name | MARK D MARILLEY MD
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Gender | Male
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 200 SE HOSPITAL AVE
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City | STUART
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State | FL
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Zip | 34994-2346
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Country | US
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Telephone | 772-287-5200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5074
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City | SIOUX FALLS
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State | SD
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Zip | 57117-5074
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | DR.0067585
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD192722
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 200700105
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD425171
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 21764
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License Number State | WV
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Taxonomy #6
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 21216
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License Number State | ND
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Taxonomy #7
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 350085209
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License Number State | GA
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Taxonomy #8
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME157995
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License Number State | FL
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