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General NPI Number Information
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NPI Number | 1013298686
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Entity Type | Individual
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Provider Name | MR. RANDY LEROY MARX
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Gender | Male
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Dates
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Enumeration Date | 09/08/2011
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Last Update Date | 06/21/2013
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Provider Practice Location Address
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Address Line | 1401 NWAKAMA ST STE 100
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City | MARSHALL
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State | MN
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Zip | 56258-5530
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Country | US
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Telephone | 507-337-4500
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Fax | 507-337-4502
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Provider Business Mailing Address
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Address Line | 1401 NWAKAMA ST STE 100
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City | MARSHALL
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State | MN
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Zip | 56258-5530
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Country | US
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Telephone | 507-337-4500
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Fax | 507-337-4502
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 2612
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License Number State | MN
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