Provider Demographics
NPI:1063516474
Name:MARR, DREW J (PAC)
Entity type:Individual
Prefix:MISS
First Name:DREW
Middle Name:J
Last Name:MARR
Suffix:
Gender:M
Credentials:PAC
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Mailing Address - Street 1:600 CAISSON HILL ROAD
Mailing Address - Street 2:ATTN: MCXX-CLD-QM
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442-5037
Mailing Address - Country:US
Mailing Address - Phone:785-239-7155
Mailing Address - Fax:785-239-7364
Practice Address - Street 1:600 CAISSON HILL ROAD
Practice Address - Street 2:ATTN: MCXX-CLD-QM
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-5037
Practice Address - Country:US
Practice Address - Phone:785-239-7155
Practice Address - Fax:785-239-7364
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS1501031363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant