Provider Demographics
NPI:1043248677
Name:MARVEL, JAMES EBBERT (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EBBERT
Last Name:MARVEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9477
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-9477
Mailing Address - Country:US
Mailing Address - Phone:903-594-2450
Mailing Address - Fax:903-509-0493
Practice Address - Street 1:108 PARKER ST
Practice Address - Street 2:STE 400
Practice Address - City:QUITMAN
Practice Address - State:TX
Practice Address - Zip Code:75783-2102
Practice Address - Country:US
Practice Address - Phone:903-763-6144
Practice Address - Fax:903-763-6146
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0996207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103185804Medicaid
200044978OtherMEDICARE RR
200044978Medicare PIN
TX103185804Medicaid
TX8683B7Medicare PIN
TX8L2746Medicare PIN