Provider Demographics
NPI:1962761791
Name:HARVEY, MARVIN RYAN (MD)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:RYAN
Last Name:HARVEY
Suffix:
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:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1330
Mailing Address - Country:US
Mailing Address - Phone:405-307-3026
Mailing Address - Fax:405-515-5114
Practice Address - Street 1:2320 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-1741
Practice Address - Country:US
Practice Address - Phone:059-123-9304
Practice Address - Fax:405-912-3931
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK30212207Q00000X, 208D00000X
TXBP10065049207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine