Provider Demographics
NPI:1811565955
Name:MARLOW, ANTONIO M
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:M
Last Name:MARLOW
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 1:2305 HUSSON AVE APT M93
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-6527
Mailing Address - Country:US
Mailing Address - Phone:904-831-4170
Mailing Address - Fax:
Practice Address - Street 1:2305 HUSSON AVE APT M93
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-6527
Practice Address - Country:US
Practice Address - Phone:904-831-4170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver