1225333156 NPI number — JASON E. MARKER, M.D., P.C.

Table of content: (NPI 1225333156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225333156 NPI number — JASON E. MARKER, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JASON E. MARKER, M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225333156
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
66642 SRTATE ROAD 331
Provider Second Line Business Mailing Address:
P.O. BOX 90
Provider Business Mailing Address City Name:
WYATT
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-633-4511
Provider Business Mailing Address Fax Number:
574-633-0281

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
66642 SRTATE ROAD 331
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYATT
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-633-4511
Provider Business Practice Location Address Fax Number:
574-633-0281
Provider Enumeration Date:
01/25/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARKER
Authorized Official First Name:
JASON
Authorized Official Middle Name:
ERIC
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
574-633-4511

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  01050905 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)