Healthcare Provider Details

I. General information

NPI: 1013990555
Provider Name (Legal Business Name): ALEXANDER MARSH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10180 SE SUNNYSIDE RD KAISER PERMANENTE
CLACKAMAS OR
97015-8970
US

IV. Provider business mailing address

10180 SE SUNNYSIDE RD KAISER SUNNYSIDE MEDICAL OFFICE
CLACKAMAS OR
97015-9764
US

V. Phone/Fax

Practice location:
  • Phone: 503-571-8488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01060628A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberMD26322
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: