Provider Demographics
NPI:1528301728
Name:MARKS, ETAN (DO)
Entity type:Individual
Prefix:DR
First Name:ETAN
Middle Name:
Last Name:MARKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 SOUTHHALL LN STE 300
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7172
Mailing Address - Country:US
Mailing Address - Phone:866-400-3376
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:1300 NW 17TH AVE STE 130A
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-2578
Practice Address - Country:US
Practice Address - Phone:866-400-3376
Practice Address - Fax:561-549-0173
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16116207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology