Provider Demographics
NPI:1760098628
Name:MARION, REID
Entity Type:Individual
Prefix:
First Name:REID
Middle Name:
Last Name:MARION
Suffix:
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 1:21420 COLT RD
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-9803
Mailing Address - Country:US
Mailing Address - Phone:510-673-3836
Mailing Address - Fax:
Practice Address - Street 1:21420 COLT RD
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-9803
Practice Address - Country:US
Practice Address - Phone:510-673-3836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program