Individual
MARVIN N. HEYBOER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
750 E ADAMS ST, SYRACUSE, NY 13210-2342
(315) 464-4863
(315) 464-8690
Mailing address
750 E ADAMS ST, SYRACUSE, NY 13210-2342
(315) 464-4863
(315) 464-8690
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
255162
NY
207P00000X
Emergency Medicine Physician
A82212
CA
207PE0005X
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
Primary
255162
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02920730
—
NY
Enumeration date
08/25/2006
Last updated
05/11/2010
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