Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | C5216 | AR |
NPI | 1023273554 |
---|---|
Provider Name | Dr. Peter Michael Marvin |
First Address | North Little Rock, AR 72117-2922 |
Second Address | North Little Rock, AR 72117-2922 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2008 |
Last Update Date | 24/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B90413 | (02) | AR |