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General NPI Number Information
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NPI Number | 1255300166
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Entity Type | Individual
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Provider Name | DENNIS JAMES MARSHALL CPO
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Gender | Male
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 08/20/2008
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Provider Practice Location Address
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Address Line | 13 TIMBERLAND DR
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City | FAIRBANKS
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State | AK
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Zip | 99701-3143
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Country | US
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Telephone | 907-374-3381
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Fax | 907-374-3380
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Provider Business Mailing Address
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Address Line | 13 TIMBERLAND DR
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City | FAIRBANKS
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State | AK
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Zip | 99701-3143
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Country | US
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Telephone | 907-374-3381
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Fax | 907-374-3380
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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 | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | CPO00873
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License Number State | CA
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