Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 10120R | LA |
Y | 207SG0201X | Clinical Genetics (M.D.) | 89-257 | NM |
N | 208000000X | Pediatrician | 10120R | LA |
NPI | 1699798603 |
---|---|
Provider Name | Michael Ray Marble |
First Address | New Orleans, LA 70118-5720 |
Second Address | New Orleans, LA 70118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 22/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00112369 | (05) | MS |
1974358 | (05) | LA |
E22704 | (02) |