Provider Demographics
NPI:1730141383
Name:ATCHISON, MARVIN J (MD)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:J
Last Name:ATCHISON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:36320 INLAND VALLEY DR.
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7512
Mailing Address - Country:US
Mailing Address - Phone:480-354-3200
Mailing Address - Fax:480-354-0391
Practice Address - Street 1:36320 INLAND VALLEY DR.
Practice Address - Street 2:SUITE 101A
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7512
Practice Address - Country:US
Practice Address - Phone:480-354-3200
Practice Address - Fax:480-354-0391
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2019-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA70292208600000X
AZ50639208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH97635Medicare UPIN