Doctor Name: | STEVENS CLOYD MARSHALL |
NPI Number: | 1396740585 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | 02001282 |
Business Practice Address: | 407 N Main St Middlebury, IN - 465409218 |
Business Phone Number: | 5748258184 |
Business Fax Number: | 5748256176 |
Mailing Address: | Po Box 1239, TROY |
State: | MI |
Postal Code: | 480991239 |
Phone Number: | 2488246600 |
Fax Number: | 8556186655 |
NPI Enumeration Date: | 06/15/2005 |
NPI Last Update Date: | 07/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 02001282 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |