Individual
STEVENS CLOYD MARSHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
450 TATONE ST, BOARDMAN, OR 97818-8076
(541) 481-7212
(541) 481-5400
Mailing address
PO BOX 397, BOARDMAN, OR 97818-0397
(541) 481-7212
(541) 481-5400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02001282
IN
208D00000X
General Practice Physician
02001282
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
268743
BLUE CROSS BLUE SHIELD
IN
Enumeration date
06/15/2005
Last updated
03/22/2018
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