Individual
MARLON S BAZAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
315 W 15TH ST, LIBERAL, KS 67901-2455
(620) 629-6477
(620) 629-6651
Mailing address
PO BOX 1340, LIBERAL, KS 67905-1340
(620) 629-6638
(620) 629-6684
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1502129
KS
Other
Enumeration date
09/14/2018
Last updated
09/14/2018
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