Provider Demographics
NPI:1154505212
Name:MARLAN ENT PLLC
Entity Type:Organization
Organization Name:MARLAN ENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-357-8700
Mailing Address - Street 1:111 MARKET ST NE STE 355
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1070
Mailing Address - Country:US
Mailing Address - Phone:360-357-8700
Mailing Address - Fax:360-357-1149
Practice Address - Street 1:111 MARKET ST NE STE 355
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1070
Practice Address - Country:US
Practice Address - Phone:360-357-8700
Practice Address - Fax:360-357-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032688174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB35207Medicare PIN