MEDICARE: ERIK DAVID MARKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1002X	Independent Duty Corpsman	M626-2048-5059-05	WI

General Provider Information

NPI Number	:	1013359835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIK DAVID MARKER

Provider Business Mailing Address
First Line	:	W215N10364 LAUREL CT
Second Line	:
City	:	COLGATE
State	:	WI
Zip	:	53017-9513
Country	:	US
Telephone Number	:	262-894-8301
Fax Number	:

Provider Business Practice Location Address
First Line	:	3402 TARAWA RD
Second Line	:	BLDG 19
City	:	SAN DIEGO
State	:	CA
Zip	:	92155-5176
Country	:	US
Telephone Number	:	619-437-2558
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2013
Last Update Date	:	07/22/2013

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Directions to “ ERIK DAVID MARKER ” Practice Location

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