Provider Demographics
NPI:1285681528
Name:PIBURN, MARVIN FRANKLIN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:FRANKLIN
Last Name:PIBURN
Suffix:JR
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 1:2277 IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-9106
Mailing Address - Country:US
Mailing Address - Phone:319-334-2583
Mailing Address - Fax:319-334-5252
Practice Address - Street 1:2277 IOWA AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-9106
Practice Address - Country:US
Practice Address - Phone:319-334-2583
Practice Address - Fax:319-334-5252
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA197922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0133611Medicaid
IAE42085Medicare UPIN
IA319335Medicare ID - Type UnspecifiedMEDICAL SERVICES
IA0133611Medicaid