Active NPI
Marlon G Fletchall, M.D.
- Family Medicine Physician
- Eugene, OR
National Provider Identifier
1902879935
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD09266
- Practice address
- 4010 Aerial Way
Eugene, OR 97402-9757 - Phone
- (541) 687-6353
- NPI assigned
- Feb 9, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD09266 | OR | Primary |
Addresses
Primary practice location
4010 Aerial Way
Eugene, OR 97402-9757
Mailing address
1115 SE 164TH Ave
Dept 358
Vancouver, WA 98683-9324
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 261966 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD09266 | OR | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457654400000",
"number": "1902879935",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1115 SE 164TH AVE",
"address_2": "DEPT 358",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986839324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4010 AERIAL WAY",
"city": "EUGENE",
"state": "OR",
"postal_code": "974029757",
"telephone_number": "541-687-6353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FLETCHALL",
"first_name": "MARLON",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-09",
"last_updated": "2016-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "MD09266",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "261966",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Eugene, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.