Provider Demographics
NPI:1427081025
Name:WIRGES, MARLA L (MD)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:L
Last Name:WIRGES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16221 SAINT VINCENT WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-9072
Mailing Address - Country:US
Mailing Address - Phone:501-817-3923
Mailing Address - Fax:501-817-3930
Practice Address - Street 1:16221 SAINT VINCENT WAY STE 300
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-9072
Practice Address - Country:US
Practice Address - Phone:501-817-3923
Practice Address - Fax:501-817-3930
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5842207N00000X
TXM2205207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181172101Medicaid
NM202008119OtherPRESBYTERIAN COMMERCIAL
TX8J1461OtherBLUE CROSS BLUE SHIELD
TX150336100OtherFIRSTCARE COMMERCIAL
TX150336101Medicaid
AR174846001Medicaid
OK200086270AMedicaid
TX8M1174OtherHMO BLUE
NM13588737Medicaid
TX181172102Medicaid
NM202008119Medicaid
NM202008119OtherPRESBYTERIAN COMMERCIAL
TXP00332631Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TX8G6301Medicare ID - Type Unspecified
NM13588737Medicaid