Provider Demographics
NPI:1285600759
Name:MARECLE, DONALD RAY (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:RAY
Last Name:MARECLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:212 4TH AVE SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-3673
Mailing Address - Country:US
Mailing Address - Phone:256-739-6050
Mailing Address - Fax:256-739-4921
Practice Address - Street 1:212 4TH AVE SE
Practice Address - Street 2:SUITE 100
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-3673
Practice Address - Country:US
Practice Address - Phone:256-739-6050
Practice Address - Fax:256-739-4921
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL9759208600000X
MS09303208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529702820Medicaid
AL51035588OtherBLUE CROSS OF ALABAMA
ALC70850Medicare UPIN
AL529702820Medicaid