Individual
MARVIN DWANE FICKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, MAIL CODE OP2, PORTLAND, OR 97239-3011
(503) 494-8147
Mailing address
3181 SW SAM JACKSON PARK RD, MAIL CODE OP2, PORTLAND, OR 97239-3011
(503) 494-8147
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD17565
OR
Other
Enumeration date
09/08/2006
Last updated
10/10/2013
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