Healthcare Provider Details

I. General information

NPI: 1285681528
Provider Name (Legal Business Name): MARVIN FRANKLIN PIBURN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2277 IOWA AVE
INDEPENDENCE IA
50644-9106
US

IV. Provider business mailing address

2277 IOWA AVE
INDEPENDENCE IA
50644-9106
US

V. Phone/Fax

Practice location:
  • Phone: 319-334-2583
  • Fax: 319-334-5252
Mailing address:
  • Phone: 319-334-2583
  • Fax: 319-334-5252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number19792
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: