Provider Demographics
NPI:1972681880
Name:SINGLETON, MARVIN A (MD)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:A
Last Name:SINGLETON
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 1:4474 FIVE MILE RD.
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:MO
Mailing Address - Zip Code:64865
Mailing Address - Country:US
Mailing Address - Phone:417-781-6880
Mailing Address - Fax:
Practice Address - Street 1:4474 FIVE MILE RD.
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:MO
Practice Address - Zip Code:64865
Practice Address - Country:US
Practice Address - Phone:417-781-6880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC29306207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C293060Medicaid
A11923Medicare UPIN
00C293060Medicare ID - Type Unspecified