Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 132 | AR |
NPI | 1053304303 |
---|---|
Provider Name | Dr. Clifford B Marston III |
First Address | Gassville, AR 72635-8708 |
Second Address | Gassville, AR 72635-8708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 26/08/2016 |