Provider Demographics
NPI:1255760633
Name:MARLES, STEVEN WILLIAM (MD JD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:WILLIAM
Last Name:MARLES
Suffix:
Gender:M
Credentials:MD JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4265 TAPESTRY WAY
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-7448
Mailing Address - Country:US
Mailing Address - Phone:209-535-5427
Mailing Address - Fax:209-656-1775
Practice Address - Street 1:4265 TAPESTRY WAY
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-7448
Practice Address - Country:US
Practice Address - Phone:209-535-5427
Practice Address - Fax:209-656-1775
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG45363207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA-50000Medicare UPIN
CA222-945527Medicare PIN