Provider Demographics
NPI:1679865034
Name:MARION, CLARENCE M JR
Entity Type:Individual
Prefix:MR
First Name:CLARENCE
Middle Name:M
Last Name:MARION
Suffix:JR
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 1:1411 EAST CALHOUN AVENUE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76501-4671
Mailing Address - Country:US
Mailing Address - Phone:254-534-4685
Mailing Address - Fax:
Practice Address - Street 1:1411 E CALHOUN AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76501-4671
Practice Address - Country:US
Practice Address - Phone:254-534-4685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02433373171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor