=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245246164
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN S MARSHBURN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2006
-----------------------------------------------------
Last Update Date | 11/28/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1275 N ROSE DR SUITE 112
-----------------------------------------------------
City | PLACENTIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92870-3941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-792-1199
-----------------------------------------------------
Fax | 714-792-1196
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1275 N ROSE DR SUITE 112
-----------------------------------------------------
City | PLACENTIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92870-3941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-792-1199
-----------------------------------------------------
Fax | 714-792-1196
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | A60789
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------