Provider Demographics
NPI:1639181233
Name:SPARRELL, MARVIN CHARLES (MPAS PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:CHARLES
Last Name:SPARRELL
Suffix:
Gender:M
Credentials:MPAS PA-C
Other - Prefix:
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Mailing Address - Street 1:110 S COTTERELL DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-0307
Mailing Address - Country:US
Mailing Address - Phone:208-322-4468
Mailing Address - Fax:
Practice Address - Street 1:500 W FORT ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4501
Practice Address - Country:US
Practice Address - Phone:208-422-1136
Practice Address - Fax:208-422-1243
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDPA-35363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical