Healthcare Provider Details

I. General information

NPI: 1255760633
Provider Name (Legal Business Name): STEVEN WILLIAM MARLES MD JD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4265 TAPESTRY WAY
TURLOCK CA
95382-7448
US

IV. Provider business mailing address

4265 TAPESTRY WAY
TURLOCK CA
95382-7448
US

V. Phone/Fax

Practice location:
  • Phone: 209-535-5427
  • Fax: 209-656-1775
Mailing address:
  • Phone: 209-535-5427
  • Fax: 209-656-1775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberG45363
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: