Provider Demographics
NPI:1447798533
Name:MCGOVERN, MARCUS
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:MCGOVERN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 SW BRUMBACK ST
Mailing Address - Street 2:UNIT 3259
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6899
Mailing Address - Country:US
Mailing Address - Phone:541-728-1847
Mailing Address - Fax:
Practice Address - Street 1:190 SW BRUMBACK ST
Practice Address - Street 2:UNIT 3259
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6899
Practice Address - Country:US
Practice Address - Phone:541-728-1847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program