Provider Demographics
NPI:1801826789
Name:HAND, MARSHALL RAY JR
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:RAY
Last Name:HAND
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RAY
Other - Middle Name:
Other - Last Name:HAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3106 NORCREST DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73121-1844
Mailing Address - Country:US
Mailing Address - Phone:405-557-1989
Mailing Address - Fax:
Practice Address - Street 1:3106 NORCREST DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73121-1844
Practice Address - Country:US
Practice Address - Phone:405-557-1989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK338103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100840640AMedicaid