Provider Demographics
NPI:1053559310
Name:BOSTIAN, MARC RICHARD
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:RICHARD
Last Name:BOSTIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 NW 58TH ST STE 330
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4718
Mailing Address - Country:US
Mailing Address - Phone:405-819-3241
Mailing Address - Fax:
Practice Address - Street 1:3545 NW 58TH ST STE 330
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4718
Practice Address - Country:US
Practice Address - Phone:405-819-3241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-25
Last Update Date:2009-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter