Provider Demographics
NPI:1598950313
Name:ALPINE COUNTRY UROLOGIC ASSOCIATES PC
Entity Type:Organization
Organization Name:ALPINE COUNTRY UROLOGIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-468-0018
Mailing Address - Street 1:PO BOX 438
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85547-0438
Mailing Address - Country:US
Mailing Address - Phone:928-468-0018
Mailing Address - Fax:928-468-0019
Practice Address - Street 1:111 E FRONTIER ST
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5663
Practice Address - Country:US
Practice Address - Phone:928-468-0018
Practice Address - Fax:928-468-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28174208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty