Marvin Dwane Fickle | Portland, OR • PECOS Search

Marvin Dwane Fickle

Psychiatry & Neurology

Allopathic & Osteopathic Physicians

3181 SW Sam Jackson Park Rd, Mail Code Op2, Portland, OR 97239-3011

PECOS Enrollment

Based on the most recent information from CMS, provider Marvin Dwane Fickle does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1497859623
Provider Type
Individual
Full Name
Fickle, Marvin Dwane
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
9/8/2006
Last Updated
10/10/2013

Contact Information

Practice Location

3181 SW Sam Jackson Park Rd, Mail Code Op2, Portland, OR 97239-3011

Unlisted Fax

Mailing Location

3181 SW Sam Jackson Park Rd, Mail Code Op2, Portland, OR 97239-3011

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 2084P0800X Primary	Description Psychiatry & Neurology Allopathic & Osteopathic Physicians	License MD17565 Oregon