Healthcare Provider Details

I. General information

NPI: 1750341483
Provider Name (Legal Business Name): JOSEPH MARSHALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 BESSIE AVE SUITE 108
TRACY CA
95376-3080
US

IV. Provider business mailing address

1530 BESSIE AVE SUITE 108
TRACY CA
95376-3080
US

V. Phone/Fax

Practice location:
  • Phone: 209-833-2393
  • Fax:
Mailing address:
  • Phone: 209-833-2393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number34673
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG67457
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: