Provider Demographics
NPI:1811287923
Name:MARVEL, BRETT ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ALAN
Last Name:MARVEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 OLD LORENA RD
Mailing Address - Street 2:
Mailing Address - City:LORENA
Mailing Address - State:TX
Mailing Address - Zip Code:76655-3176
Mailing Address - Country:US
Mailing Address - Phone:737-642-5062
Mailing Address - Fax:
Practice Address - Street 1:1199 OLD LORENA RD
Practice Address - Street 2:
Practice Address - City:LORENA
Practice Address - State:TX
Practice Address - Zip Code:76655-3176
Practice Address - Country:US
Practice Address - Phone:737-642-5062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-10
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5030207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201228750Medicaid
IN200640020Medicare PIN
INP01369601Medicare PIN
IN264430228Medicare PIN
IN201228750Medicaid