Doctor Name: | DUSTIN MARLEY |
NPI Number: | 1114335353 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | |
Business Practice Address: | 13055 W Mcdowell Rd Building E, Ste 109 Avondale, AZ - 853926449 |
Business Phone Number: | 8882206432 |
Business Fax Number: | |
Mailing Address: | 901 Mcclintock Dr, Suite 202 BURR RIDGE |
State: | IL |
Postal Code: | 605270872 |
Phone Number: | 8882206432 |
Fax Number: | |
NPI Enumeration Date: | 07/31/2014 |
NPI Last Update Date: | 06/04/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |