Healthcare Provider Details

I. General information

NPI: 1508880733
Provider Name (Legal Business Name): DEIRDRE MARGARET MARSHALL M.D. ,F.A.C.S., FAAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6360 SUNSET DR
MIAMI FL
33143-4836
US

IV. Provider business mailing address

6360 SUNSET DR
MIAMI FL
33143-4836
US

V. Phone/Fax

Practice location:
  • Phone: 305-663-5790
  • Fax: 305-663-3790
Mailing address:
  • Phone: 305-663-5790
  • Fax: 305-663-5730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME0064150
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: