Healthcare Provider Details

I. General information

NPI: 1164468534
Provider Name (Legal Business Name): MICHAEL JOHN MARVINNY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 MAPLE ST
ASHLAND OR
97520-1552
US

IV. Provider business mailing address

280 MAPLE ST
ASHLAND OR
97520-1552
US

V. Phone/Fax

Practice location:
  • Phone: 541-201-4000
  • Fax:
Mailing address:
  • Phone: 541-201-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberO-1352
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO26701
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: