Provider Demographics
NPI:1356483374
Name:MARBLE, MICHAEL RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RAYMOND
Last Name:MARBLE
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 1:5226 DAWN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8112
Mailing Address - Country:US
Mailing Address - Phone:503-620-2933
Mailing Address - Fax:503-620-2933
Practice Address - Street 1:5226 DAWN AVE
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-8112
Practice Address - Country:US
Practice Address - Phone:503-620-2933
Practice Address - Fax:503-620-8652
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD09926207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000BHHDRMedicare ID - Type Unspecified
CN3220Medicare UPIN