Healthcare Provider Details

I. General information

NPI: 1053304303
Provider Name (Legal Business Name): CLIFFORD B MARSTON III DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date: 03/27/2006
Reactivation Date: 04/03/2006

III. Provider practice location address

248 COUNTY ROAD 1173
GASSVILLE AR
72635-8708
US

IV. Provider business mailing address

248 COUNTY ROAD 1173
GASSVILLE AR
72635-8708
US

V. Phone/Fax

Practice location:
  • Phone: 870-405-4428
  • Fax:
Mailing address:
  • Phone: 870-405-4428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number132
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: