Individual
EDWIN MARRERO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1615 DELAWARE ST, LONGVIEW, WA 98632-2367
(360) 501-3601
(360) 501-3648
Mailing address
1115 SE 164TH AVE DEPT 358, VANCOUVER, WA 98683-8004
(360) 729-1462
(360) 729-3104
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD60460446
WA
208M00000X
Hospitalist Physician
Primary
MD60460446
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2036933
—
WA
05
—
500673085
—
OR
Enumeration date
05/06/2011
Last updated
05/12/2015
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