MEDICARE: BRUCE A MARSHALL MD PA

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	174400000X	Specialist	9545	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356520746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUCE A MARSHALL MD PA

Provider Business Mailing Address
First Line	:	PO BOX 663
Second Line	:
City	:	CLINTON
State	:	SC
Zip	:	29325-0663
Country	:	US
Telephone Number	:	864-833-1978
Fax Number	:	864-833-7688

Provider Business Practice Location Address
First Line	:	104 MEDICAL PARK CT
Second Line	:
City	:	CLINTON
State	:	SC
Zip	:	29325-7537
Country	:	US
Telephone Number	:	864-833-1978
Fax Number	:	864-833-7688

Authorized Official
Title or Position	:	OWNER
Name	:	BRUCE A MARSHALL
Credential	:	M.D.
Telephone Number	:	864-833-1978

Provider Enumeration Date	:	11/01/2007
Last Update Date	:	11/29/2011

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