Healthcare Provider Details

I. General information

NPI: 1306822572
Provider Name (Legal Business Name): WILLIAM H. MARSHALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 W STADIUM BLVD
JEFFERSON CITY MO
65109-6023
US

IV. Provider business mailing address

PO BOX 104240
JEFFERSON CITY MO
65110-4240
US

V. Phone/Fax

Practice location:
  • Phone: 573-635-5264
  • Fax: 573-556-5757
Mailing address:
  • Phone: 573-556-5191
  • Fax: 573-556-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberR1C90
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: