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Individual

JOHN D MARIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DPM

Contact information

Practice address
7156 E GRASS LAND DR, PRESCOTT VALLEY, AZ 86314-1940
(928) 772-7450
(928) 772-7450
Mailing address
PO BOX 26790, PRESCOTT VALLEY, AZ 86312-6790
(928) 772-7450
(928) 772-7450

Taxonomy

Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
DPM443
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
333899
AZ
01
860820843
TAX ID FOR COMMERCIAL
AZ
01
AZ0191930
BCBSAZ
Enumeration date
09/26/2006
Last updated
02/04/2021
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