Provider Demographics
NPI:1649311143
Name:DOZIER, MARVIN (CSA)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:
Last Name:DOZIER
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6043 C DURHAM DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-8712
Mailing Address - Country:US
Mailing Address - Phone:561-436-8157
Mailing Address - Fax:
Practice Address - Street 1:6043 C DURHAM DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-8712
Practice Address - Country:US
Practice Address - Phone:800-348-4565
Practice Address - Fax:888-203-4247
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2897363AM0700X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical