Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 08493R | OK |
NPI | 1396701793 |
---|---|
Provider Name | Kevin Craig Marler |
First Address | Shreveport, LA 71115-2302 |
Second Address | Shreveport, LA 71115-2302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 11/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1698873 | (05) | LA |
G46935 | (02) | LA |