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General NPI Number Information
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NPI Number | 1629601695
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Entity Type | Organization
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Legal Business Name | MARATHON HEALTH LLC
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Dates
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Enumeration Date | 02/19/2020
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Last Update Date | 02/19/2020
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Provider Practice Location Address
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Address Line | 10430 RAY RD
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City | PONTE VEDRA
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State | FL
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Zip | 32081-8813
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Country | US
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Telephone | 904-671-8329
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5
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City | WINOOSKI
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State | VT
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Zip | 05404-0005
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Country | US
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Telephone | 802-857-0400
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JERRY FORD
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Credential |
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Telephone | 802-857-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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