Individual
MICHAEL JOHN MARVINNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
280 MAPLE ST, ASHLAND, OR 97520-1552
(541) 201-4000
Mailing address
280 MAPLE ST, ASHLAND, OR 97520-1552
(541) 201-4000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
DO26701
OR
208M00000X
Hospitalist Physician
Primary
O-1352
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005953
—
OR
01
—
136209
MEDICARE-TYPE UNSPECIFIED
OR
01
—
838334034
BCBS-ROSEBURG
OR
01
—
838366032
BCBS-MCMINNVILLE
OR
01
—
844477040
BCBS-GRANTS PASS
OR
01
—
858463034
BCBS-MEDFORD
OR
01
—
858464039
BCBS-SPRINGFIELD
OR
01
—
P00400668
RAIL ROAD MEDICARE
OR
Enumeration date
06/22/2006
Last updated
11/18/2021
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