Provider Demographics
NPI:1730189499
Name:MCBRIDE, MARVIN R JR (MD)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:R
Last Name:MCBRIDE
Suffix:JR
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 1:1600 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3065
Mailing Address - Country:US
Mailing Address - Phone:863-680-7000
Mailing Address - Fax:866-264-8519
Practice Address - Street 1:1600 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3065
Practice Address - Country:US
Practice Address - Phone:863-680-7000
Practice Address - Fax:866-264-8519
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039483207Q00000X, 208M00000X
WI62200-20208M00000X
FLME119775208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013013000Medicaid
000000000208OtherM-PLAN
IN100147210Medicaid
INP01168514OtherRAILROAD MEDICARE
FLHW846YOtherMEDICARE
IN000000335492OtherANTHEM BC BS
351143305002OtherTRICARE PALMETTO
FL013013000Medicaid
IN000000335492OtherANTHEM BC BS
FLHW846YOtherMEDICARE
000000000208OtherM-PLAN