Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | E4503 | TX |
NPI | 1003890930 |
---|---|
Provider Name | Dr. John R. Marchbanks |
First Address | Lubbock, TX 79408-5865 |
Second Address | Lubbock, TX 79415-3300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11705302 | (05) | NM |
20036130A | (05) | OK |
8P2610 | HMO BLUE (01) | TX |
8P2630 | BC/BS (01) | TX |
C18764 | (02) | TX |
I002 | TRIWEST (01) | NM |