Provider Demographics
NPI:1306810593
Name:HANKS, MAREL A (MD)
Entity type:Individual
Prefix:
First Name:MAREL
Middle Name:A
Last Name:HANKS
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 1:523 S FANNIN AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-8204
Mailing Address - Country:US
Mailing Address - Phone:903-535-9041
Mailing Address - Fax:
Practice Address - Street 1:1001 N PALESTINE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-4122
Practice Address - Country:US
Practice Address - Phone:903-535-9041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6271208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098542607Medicaid
TX098542608Medicaid
TX8B0528OtherBCBS
TX098542606Medicaid
TX45-2578435-006OtherTRICARE
TX45-2578435OtherTRICARE
TX098542609Medicaid
TX8DL007OtherBCBS
TX098542609Medicaid
TX8DL007OtherBCBS
TX8B6214Medicare PIN