Healthcare Provider Details

I. General information

NPI: 1770782245
Provider Name (Legal Business Name): JAMES RICHARD MARZOLF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 BROWN STATION RD
COLUMBIA MO
65202-2207
US

IV. Provider business mailing address

3005 BROWN STATION RD
COLUMBIA MO
65202-2207
US

V. Phone/Fax

Practice location:
  • Phone: 573-474-2345
  • Fax:
Mailing address:
  • Phone: 573-474-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number2003010744
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: