Provider Demographics
NPI:1831148196
Name:HARVILL-BROOKS, MARJORIE NICOLE (DO)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:NICOLE
Last Name:HARVILL-BROOKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:NICOLE
Other - Last Name:HARVILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:541-732-7460
Mailing Address - Fax:541-732-7460
Practice Address - Street 1:940 ROYAL AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6193
Practice Address - Country:US
Practice Address - Phone:541-732-7460
Practice Address - Fax:541-732-7461
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO154075207V00000X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500634857OtherMEDICAID
ORR160442Medicare PIN