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General NPI Number Information
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NPI Number | 1356520746
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Entity Type | Organization
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Legal Business Name | BRUCE A MARSHALL MD PA
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 11/29/2011
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Provider Practice Location Address
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Address Line | 104 MEDICAL PARK CT
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City | CLINTON
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State | SC
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Zip | 29325-7537
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Country | US
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Telephone | 864-833-1978
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Fax | 864-833-7688
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Provider Business Mailing Address
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Address Line | PO BOX 663
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City | CLINTON
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State | SC
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Zip | 29325-0663
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Country | US
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Telephone | 864-833-1978
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Fax | 864-833-7688
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Authorized Official
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Title or Position | OWNER
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Name | BRUCE A MARSHALL
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Credential | M.D.
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Telephone | 864-833-1978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 9545
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License Number State | SC
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