Healthcare Provider Details

I. General information

NPI: 1639116296
Provider Name (Legal Business Name): GARY E. MARSH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 TELEGRAPH RD
DOWNEY CA
90240-2393
US

IV. Provider business mailing address

DEPT LA 23039
PASADENA CA
91185-3039
US

V. Phone/Fax

Practice location:
  • Phone: 562-861-0954
  • Fax: 562-231-1904
Mailing address:
  • Phone: 562-282-4038
  • Fax: 562-658-3397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA20613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: