Provider Demographics
NPI:1366453177
Name:MARKS, JARED DUANE (PA-C)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:DUANE
Last Name:MARKS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14140 SOUTHWEST FWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3842
Mailing Address - Country:US
Mailing Address - Phone:281-649-7000
Mailing Address - Fax:281-240-0030
Practice Address - Street 1:780 W SAM HOUSTON PKWY N STE 400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-3944
Practice Address - Country:US
Practice Address - Phone:281-649-7500
Practice Address - Fax:713-468-1255
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.A10381.RX363A00000X
TXPA11196363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1626694Medicaid
LA1626694Medicaid
LA57038P750Medicare ID - Type Unspecified