Provider Demographics
NPI:1437155686
Name:MARX, DOUGLAS WILLIAM (MD)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:WILLIAM
Last Name:MARX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 HIGHWAY 201 N
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3158
Mailing Address - Country:US
Mailing Address - Phone:870-424-2020
Mailing Address - Fax:
Practice Address - Street 1:140 HIGHWAY 201 N
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3158
Practice Address - Country:US
Practice Address - Phone:870-424-2020
Practice Address - Fax:870-425-4840
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3778207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180032996OtherPALMETTO GBA - RAILROAD MEDICARE
AR113788001Medicaid
ARD04542Medicare UPIN
MO0352090001Medicare NSC
517566942Medicare PIN
AR113788001Medicaid
AR51756Medicare ID - Type Unspecified