Provider Demographics
NPI:1700299393
Name:MARZAN, EMILIO (DO)
Entity type:Individual
Prefix:DR
First Name:EMILIO
Middle Name:
Last Name:MARZAN
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:FORT RICHARDSON TROOP MEDICAL CLINIC
Mailing Address - Street 2:1-501 BATTALION SURGEON
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99505
Mailing Address - Country:US
Mailing Address - Phone:907-384-8087
Mailing Address - Fax:
Practice Address - Street 1:5005 N PIEDRAS ST
Practice Address - Street 2:5005 N PIEDRAS STREET
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920-5001
Practice Address - Country:US
Practice Address - Phone:915-742-2180
Practice Address - Fax:915-742-3238
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1398207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine