MEDICARE: MRS. LUCIANNE MARIN M.D.

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	208000000X	Pediatrics Physician	P8503	TX

General Provider Information

NPI Number	:	1821024654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LUCIANNE MARIN M.D.

Provider Business Mailing Address
First Line	:	523 S FANNIN AVE
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75702-8204
Country	:	US
Telephone Number	:	903-535-9041
Fax Number	:	903-531-9490

Provider Business Practice Location Address
First Line	:	1001 S PALESTINE ST
Second Line	:
City	:	ATHENS
State	:	TX
Zip	:	75751-3614
Country	:	US
Telephone Number	:	903-535-9041
Fax Number	:	903-904-5085

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	02/02/2026

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