Individual
JEFFREY BLAINE MARVEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1821 N WASHINGTON ST, TULLAHOMA, TN 37388-2221
(931) 455-2005
(931) 455-4450
Mailing address
1821 N WASHINGTON ST, TULLAHOMA, TN 37388-2221
(931) 455-2005
(931) 455-4450
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
29420
TN
207Y00000X
Otolaryngology Physician
Primary
87585
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3057919
BLUE CROSS BLUE SHIELD
TN
05
—
3812095
—
TN
Enumeration date
06/14/2005
Last updated
03/05/2025
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