Active NPI
Jacob Michael Marks, M.D.
- Plastic Surgery Physician
- Gilbert, AZ
National Provider Identifier
1134654924
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- 72603
- Practice address
- 1981 E Bonanza CT Ste 102
Gilbert, AZ 85297-8014 - Phone
- (480) 466-7355
- NPI assigned
- Apr 28, 2017
- Last updated
- Jul 26, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | 72603 | AZ | Primary |
Addresses
Primary practice location
1981 E Bonanza CT Ste 102
Gilbert, AZ 85297-8014
Mailing address
4111 S Silverado St Unit 188
Gilbert, AZ 85297-0119
Phone (724) 713-7471
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 72603 | AZ | MD | Plastic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1493337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721952000000",
"number": "1134654924",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4111 S SILVERADO ST UNIT 188",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852970119",
"telephone_number": "724-713-7471"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1981 E BONANZA CT STE 102",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852978014",
"telephone_number": "480-466-7355"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARKS",
"first_name": "JACOB",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-04-28",
"last_updated": "2024-07-26",
"certification_date": "2024-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "AZ",
"license": "72603",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gilbert, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.