Basic Information
| Provider Information | |||||||||
| NPI: | 1922190925 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARR | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4515 | ||||||||
| Address2: | |||||||||
| City: | BRYAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 778054515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9797767564 | ||||||||
| FaxNumber: | 9797760873 | ||||||||
| Practice Location | |||||||||
| Address1: | 3030 UNIVERSITY DR E STE 100 | ||||||||
| Address2: | |||||||||
| City: | COLLEGE STATION | ||||||||
| State: | TX | ||||||||
| PostalCode: | 778456147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9797767564 | ||||||||
| FaxNumber: | 9797760873 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 07/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | F6907 | TX | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 083529001 | 05 | TX | MEDICAID |