Healthcare Provider Details

I. General information

NPI: 1912986878
Provider Name (Legal Business Name): WESLEY DARRELL MARNER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 03/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 N RANDOLPH AVE B
EUFAULA AL
36027-1631
US

IV. Provider business mailing address

PO BOX 40
EUFAULA AL
36072-0040
US

V. Phone/Fax

Practice location:
  • Phone: 334-687-1973
  • Fax: 334-687-1972
Mailing address:
  • Phone: 334-687-1973
  • Fax: 334-687-1972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO-355
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: