MEDICARE: EZRA MARSHALL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	ME14059	FL

General Provider Information

NPI Number	:	1245336171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EZRA MARSHALL MD

Provider Business Mailing Address
First Line	:	1451 BINNEY DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34949-3109
Country	:	US
Telephone Number	:	772-332-2251
Fax Number	:

Provider Business Practice Location Address
First Line	:	1451 BINNEY DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34949-3109
Country	:	US
Telephone Number	:	772-332-2251
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	07/08/2007

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