Healthcare Provider Details

I. General information

NPI: 1811612682
Provider Name (Legal Business Name): MARVIN JOSEPH REESE CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 W LILY LN
EDMOND OK
73025-1020
US

IV. Provider business mailing address

171 W LILY LN
EDMOND OK
73025-1020
US

V. Phone/Fax

Practice location:
  • Phone: 405-706-1751
  • Fax:
Mailing address:
  • Phone: 405-706-1751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: