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General NPI Number Information
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NPI Number | 1114018132
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Entity Type | Individual
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Provider Name | LARRY J MARSHALL MD
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Gender | Male
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 12517 LAKESHORE DR
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City | LAKESIDE
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State | CA
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Zip | 92040-3103
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Country | US
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Telephone | 619-443-3843
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Fax | 619-390-1810
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Provider Business Mailing Address
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Address Line | 12517 LAKESHORE DR
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City | LAKESIDE
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State | CA
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Zip | 92040-3103
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Country | US
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Telephone | 619-443-3843
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Fax | 619-390-1810
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 16913
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A52344
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License Number State | CA
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