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NPI Code Detail

MEDICARE: DARYL S. MARX M.D., L.L.C.

MEDICARE: DARYL S. MARX M.D., L.L.C.
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
1174400000XSpecialistMD.024323LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14379459970OTHERLABLUE CROSS BLUE SHIELD
21063462695OTHERINDIVIDUAL NPI
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114195658
Entity Type Code : Organization
Provider Name (Legal Business Name) : DARYL S. MARX M.D., L.L.C.
Provider Business Mailing Address
First Line : 3418 MEDICAL PARK DR
Second Line : SUITE 1
City : MONROE
State : LA
Zip : 71203-2376
Country : US
Telephone Number : 318-398-9709
Fax Number : 318-398-9711
Provider Business Practice Location Address
First Line : 3418 MEDICAL PARK DR
Second Line : SUITE 1
City : MONROE
State : LA
Zip : 71203-2376
Country : US
Telephone Number : 318-398-9709
Fax Number : 318-398-9711
Authorized Official
Title or Position : OWNER
Name : DR. DARYL S. MARX
Credential : M.D.
Telephone Number : 318-398-9709
Provider Enumeration Date : 02/19/2008
Last Update Date : 02/19/2008

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