Marvin Dwane Fickle, MD
Psychiatry & Neurology, Psychiatry in Portland, OR. Individual provider (NPI-1).
NPI number1497859623
StatusActive
Last updated in NPPESOct 10, 2013
Details
- NPI
- 1497859623
- Entity type
- Individual (NPI-1)
- Name
- Marvin Dwane Fickle
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Sep 8, 2006
- Last updated
- Oct 10, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology, Psychiatry | MD17565 | OR | Yes |
Practice location
3181 Sw Sam Jackson Park RdMail Code Op2
Portland, OR 97239-3011
Phone 503-494-8147
Mailing address
3181 Sw Sam Jackson Park RdMail Code Op2
Portland, OR 97239-3011
Phone 503-494-8147
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