Healthcare Provider Details

I. General information

NPI: 1730337429
Provider Name (Legal Business Name): MARCUS LEE POWLEY RPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 HILYARD ST
EUGENE OR
97401-3718
US

IV. Provider business mailing address

PO BOX 53
EUGENE OR
97440-0053
US

V. Phone/Fax

Practice location:
  • Phone: 541-687-7134
  • Fax: 541-687-7135
Mailing address:
  • Phone: 541-687-7134
  • Fax: 541-687-7135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number104126
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: