Provider Demographics
NPI:1730337429
Name:POWLEY, MARCUS LEE (RPA)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:LEE
Last Name:POWLEY
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 53
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-0053
Mailing Address - Country:US
Mailing Address - Phone:541-687-7134
Mailing Address - Fax:541-687-7135
Practice Address - Street 1:1255 HILYARD ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3718
Practice Address - Country:US
Practice Address - Phone:541-687-7134
Practice Address - Fax:541-687-7135
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR104126363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical