Provider Demographics
NPI:1518947522
Name:PINZON, MARVIN FELIPE (DO)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:FELIPE
Last Name:PINZON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:MARV
Other - Middle Name:F
Other - Last Name:PINZON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2929 WATSON BLVD STE 2
Mailing Address - Street 2:PMB 125
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-9601
Mailing Address - Country:US
Mailing Address - Phone:478-333-3603
Mailing Address - Fax:478-333-3685
Practice Address - Street 1:1601 WATSON BLVD
Practice Address - Street 2:ATTN: RADIOLOGY DEPARTMENT
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3431
Practice Address - Country:US
Practice Address - Phone:478-333-3603
Practice Address - Fax:478-333-3685
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0396582085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000883374Medicaid
GAP01064632OtherRAILROAD MEDICARE
GAG28621Medicare UPIN
GA000883374Medicaid
GA202I308871Medicare PIN