Individual
DR. TRENT WRIGHT MARCUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5722 INTEGRITY DR, BUILDING S771, MILLINGTON, TN 38054-5028
(901) 874-6119
Mailing address
612 LEAH LN, MANILA, AR 72442-9128
(870) 561-1277
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
R-4476
AR
207Q00000X
Family Medicine Physician
11359
NV
207Q00000X
Family Medicine Physician
Primary
R4476
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100506021
—
NV
01
—
11359
NEVADA LICENSE
NV
01
—
CC7692
BLUE CROSS PROVIDER ID
NV
01
—
R-4476
ARKANSAS LICENSE
AR
Enumeration date
05/05/2006
Last updated
04/11/2012
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