Healthcare Provider Details

I. General information

NPI: 1235498254
Provider Name (Legal Business Name): MARVIN LOUIS POOLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MARVIN LOUIS POOLE M.D.

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 SOUTHRIDGE DR
MOUNT IDA AR
71957-8802
US

IV. Provider business mailing address

6 SOUTHRIDGE DR.
MOUNT IDA AR
71957-8802
US

V. Phone/Fax

Practice location:
  • Phone: 870-867-2932
  • Fax:
Mailing address:
  • Phone: 870-867-2932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC-4964
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: