Provider Demographics
NPI:1124361399
Name:MARR, JEFFREY ALLEN (IDMT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALLEN
Last Name:MARR
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 TOP HILL RD
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-9499
Mailing Address - Country:US
Mailing Address - Phone:270-945-6411
Mailing Address - Fax:
Practice Address - Street 1:477 TOP HILL RD
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-9499
Practice Address - Country:US
Practice Address - Phone:270-945-6411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians